=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255399663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRX HOLDINGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2006
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 318 N LINCOLN ST
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50138-2714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-828-7312
-----------------------------------------------------
Fax | 641-828-6303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2929 WESTOWN PKWY STE 100
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50266-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-440-1270
-----------------------------------------------------
Fax | 515-222-2658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL FULLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 515-321-7644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 758
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 758
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------