Provider Demographics
NPI:1619998689
Name:GRM PHARMACY, LLC
Entity Type:Organization
Organization Name:GRM PHARMACY, LLC
Other - Org Name:GLEN ROCK MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KARALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-545-6040
Mailing Address - Street 1:3070 MCCANN FARM DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-2131
Mailing Address - Country:US
Mailing Address - Phone:610-545-6040
Mailing Address - Fax:
Practice Address - Street 1:210 ROCK RD
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1707
Practice Address - Country:US
Practice Address - Phone:201-444-3200
Practice Address - Fax:201-444-5792
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELWYN PHARMACY GROUP, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS003440003336C0003X, 3336C0003X
NY0318363336C0003X
OH0226243003336C0003X
SD400-16023336C0003X
KYNJ23293336C0003X
MN2654233336C0003X
PANP0005233336C0003X
CTPCN.00028903336C0003X
MI53010113263336C0003X
IN64002466A3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4349504Medicaid
2143668OtherPK
NJ4349504Medicaid