Healthcare Provider Details

I. General information

NPI: 1528017647
Provider Name (Legal Business Name): GRX HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E 14TH ST
DES MOINES IA
50316-2404
US

IV. Provider business mailing address

1300 E 14TH ST
DES MOINES IA
50316-2404
US

V. Phone/Fax

Practice location:
  • Phone: 515-283-1782
  • Fax: 515-263-8134
Mailing address:
  • Phone: 515-283-1782
  • Fax: 515-263-8134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number692
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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