Provider Demographics
NPI:1700144128
Name:GRX HOLDINGS, LLC
Entity type:Organization
Organization Name:GRX HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-321-7644
Mailing Address - Street 1:9379 SWANSON BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-6942
Mailing Address - Country:US
Mailing Address - Phone:515-962-9314
Mailing Address - Fax:515-219-7700
Practice Address - Street 1:9379 SWANSON BLVD STE E
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-6942
Practice Address - Country:US
Practice Address - Phone:515-962-9314
Practice Address - Fax:515-219-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11053336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy