MEDICARE: GRANDVIEW PHARMACY 11

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	60005826A	IN

General Provider Information

NPI Number	:	1093765315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDVIEW PHARMACY 11

Provider Business Mailing Address
First Line	:	2230 N PARK RD
Second Line	:
City	:	CONNERSVILLE
State	:	IN
Zip	:	47331-2903
Country	:	US
Telephone Number	:	765-827-0847
Fax Number	:	765-827-7503

Provider Business Practice Location Address
First Line	:	202 E MAIN ST
Second Line	:
City	:	CAMBRIDGE CITY
State	:	IN
Zip	:	47327-1239
Country	:	US
Telephone Number	:	765-478-9978
Fax Number	:	765-478-9982

Authorized Official
Title or Position	:	CEO
Name	:	RHONDA ELDRIDGE
Credential	:
Telephone Number	:	765-827-0847

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/22/2020

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Directions to “GRANDVIEW PHARMACY 11 ” Practice Location

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