Healthcare Provider Details

I. General information

NPI: 1700144128
Provider Name (Legal Business Name): GRX HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9379 SWANSON BLVD STE E
CLIVE IA
50325-6942
US

IV. Provider business mailing address

9379 SWANSON BLVD STE E
CLIVE IA
50325-6942
US

V. Phone/Fax

Practice location:
  • Phone: 515-962-9314
  • Fax: 515-219-7700
Mailing address:
  • Phone: 515-962-9314
  • Fax: 515-219-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number1105
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL FULLER
Title or Position: PRESIDENT
Credential:
Phone: 515-321-7644