Provider Demographics
NPI:1558359372
Name:G AND R INC
Entity Type:Organization
Organization Name:G AND R INC
Other - Org Name:MEDICAP PHARMACY #8435
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:208-288-1496
Mailing Address - Street 1:424 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NYSSA
Mailing Address - State:OR
Mailing Address - Zip Code:97913-3900
Mailing Address - Country:US
Mailing Address - Phone:541-372-2222
Mailing Address - Fax:541-372-2928
Practice Address - Street 1:217 MAIN ST
Practice Address - Street 2:
Practice Address - City:NYSSA
Practice Address - State:OR
Practice Address - Zip Code:97913-3843
Practice Address - Country:US
Practice Address - Phone:541-372-2222
Practice Address - Fax:541-372-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR207852Medicaid