MEDICARE: GRUBBS PHARMACY, LLC

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1518264555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRUBBS PHARMACY, LLC

Provider Business Mailing Address
First Line	:	2714 PHILADELPHIA PIKE
Second Line	:
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2568
Country	:	US
Telephone Number	:	302-791-9899
Fax Number	:	302-791-9996

Provider Business Practice Location Address
First Line	:	2714 PHILADELPHIA PIKE
Second Line	:
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2568
Country	:	US
Telephone Number	:	302-791-9899
Fax Number	:	302-791-9996

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. AMAR VN PADMANABHUNI
Credential	:
Telephone Number	:	410-409-8021

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	10/01/2013

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