Provider Demographics
NPI:1912956020
Name:GRX HOLDINGS LLC
Entity Type:Organization
Organization Name:GRX HOLDINGS LLC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER /PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:515-440-1270
Mailing Address - Street 1:800 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-9716
Mailing Address - Country:US
Mailing Address - Phone:515-989-3261
Mailing Address - Fax:515-989-4140
Practice Address - Street 1:800 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-9716
Practice Address - Country:US
Practice Address - Phone:515-989-3261
Practice Address - Fax:515-989-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
IA4253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1619569OtherNCPDP #
IABM6141787OtherDEA #
IABM6141787OtherDEA #
IA1619569OtherNCPDP #
IAIB1186Medicare PIN
IA1619569OtherNCPDP #