Provider Demographics
NPI:1669648002
Name:ELK CITY RX INC
Entity Type:Organization
Organization Name:ELK CITY RX INC
Other - Org Name:GRANDVIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:580-225-5550
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648
Mailing Address - Country:US
Mailing Address - Phone:580-225-5550
Mailing Address - Fax:580-225-6658
Practice Address - Street 1:2406 BELL AVE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2262
Practice Address - Country:US
Practice Address - Phone:580-225-5550
Practice Address - Fax:280-225-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6081110001Medicare NSC