Healthcare Provider Details

I. General information

NPI: 1073764973
Provider Name (Legal Business Name): GRIPKA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15415 PINEHURST DR
BASEHOR KS
66007-8237
US

IV. Provider business mailing address

15415 PINEHURST DR
BASEHOR KS
66007-8237
US

V. Phone/Fax

Practice location:
  • Phone: 913-724-3666
  • Fax: 913-724-3667
Mailing address:
  • Phone: 913-724-3666
  • Fax: 913-724-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-10403
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HOLLY GRIPKA
Title or Position: PHARMD/OWNER
Credential: PHARMD
Phone: 913-724-3666