=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508895525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRCY PHARMACIES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 08/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36101 BOB HOPE DR
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-321-1006
-----------------------------------------------------
Fax | 760-321-8912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36101 BOB HOPE DR
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-321-1006
-----------------------------------------------------
Fax | 760-321-8912
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROB MCDOUGALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-906-5721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 54075
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------