Provider Demographics
NPI:1760432173
Name:GRANDVIEW PHARMACY, INC.
Entity Type:Organization
Organization Name:GRANDVIEW PHARMACY, INC.
Other - Org Name:GRANDVIEW MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:317-858-6600
Mailing Address - Street 1:474 SOUTHPOINT CIR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2203
Mailing Address - Country:US
Mailing Address - Phone:866-827-7575
Mailing Address - Fax:800-228-0844
Practice Address - Street 1:2330 N PARK RD
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2904
Practice Address - Country:US
Practice Address - Phone:866-827-7575
Practice Address - Fax:800-228-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2017-12-27
Deactivation Date:2017-12-11
Deactivation Code:
Reactivation Date:2017-12-27
Provider Licenses
StateLicense IDTaxonomies
IN60002003A332BC3200X, 332BP3500X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100295600Medicaid
IN0200500001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
0200500001Medicare NSC