Healthcare Provider Details

I. General information

NPI: 1578014213
Provider Name (Legal Business Name): GRX HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W WALNUT ST
OGDEN IA
50212-3048
US

IV. Provider business mailing address

305 W WALNUT ST
OGDEN IA
50212-3048
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-2311
  • Fax: 515-432-8562
Mailing address:
  • Phone: 515-432-2311
  • Fax: 515-432-8562

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 TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number1586
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1586
License Number StateIA

VIII. Authorized Official

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