Provider Demographics
NPI:1659447431
Name:G.R.C. INC.
Entity Type:Organization
Organization Name:G.R.C. INC.
Other - Org Name:RUDYS HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECT
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-382-8621
Mailing Address - Street 1:1802 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3639
Mailing Address - Country:US
Mailing Address - Phone:229-382-8621
Mailing Address - Fax:229-382-1041
Practice Address - Street 1:1802 LEE AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3639
Practice Address - Country:US
Practice Address - Phone:229-382-8621
Practice Address - Fax:229-382-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5553332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114963OtherNABP
GA00453395AMedicaid
GA1214290001Medicare NSC