Provider Demographics
NPI:1831409846
Name:GRX HOLDINGS LLC
Entity type:Organization
Organization Name:GRX HOLDINGS LLC
Other - Org Name:
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 1:950 28TH AVE SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009
Mailing Address - Country:US
Mailing Address - Phone:515-957-0001
Mailing Address - Fax:515-957-0004
Practice Address - Street 1:950 28TH AVE SW
Practice Address - Street 2:SUITE 1
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-3927
Practice Address - Country:US
Practice Address - Phone:515-957-0001
Practice Address - Fax:515-957-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-12
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
IA11303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1831409846Medicaid
2127125OtherPK
2127125OtherPK