Provider Demographics
NPI:1871675124
Name:GRAND CARE PHARMACY INC
Entity Type:Organization
Organization Name:GRAND CARE PHARMACY INC
Other - Org Name:GRAND CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:940-482-1972
Mailing Address - Street 1:2103 W IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2737
Mailing Address - Country:US
Mailing Address - Phone:405-222-2273
Mailing Address - Fax:405-222-2546
Practice Address - Street 1:2103 W IOWA AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2737
Practice Address - Country:US
Practice Address - Phone:405-222-2273
Practice Address - Fax:405-222-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
OK18-76773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2076449OtherPK
OK100247460AMedicaid
OK100247460BMedicaid
OK100247460AMedicaid
OK185702OtherSTATE LICENSE