Provider Demographics
NPI:1821391483
Name:GRUBBS CARE PHARMACY NW INC.
Entity Type:Organization
Organization Name:GRUBBS CARE PHARMACY NW INC.
Other - Org Name:GRUBBS CARE PHARMACY NW INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SVP PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-254-9011
Mailing Address - Street 1:31 DEBEVOISE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4196
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1517 17TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6230
Practice Address - Country:US
Practice Address - Phone:202-503-2644
Practice Address - Fax:202-503-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
DCRX11004323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821391483Medicaid
MD335114900Medicaid
DC020841500Medicaid
2128132OtherPK