MEDICARE: GRX HOLDINGS, 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	3336C0004X	Compounding Pharmacy	1105	IA

General Provider Information

NPI Number	:	1700144128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRX HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	9379 SWANSON BLVD STE E
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-6942
Country	:	US
Telephone Number	:	515-962-9314
Fax Number	:	515-219-7700

Provider Business Practice Location Address
First Line	:	9379 SWANSON BLVD STE E
Second Line	:
City	:	CLIVE
State	:	IA
Zip	:	50325-6942
Country	:	US
Telephone Number	:	515-962-9314
Fax Number	:	515-219-7700

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL FULLER
Credential	:
Telephone Number	:	515-321-7644

Provider Enumeration Date	:	04/24/2012
Last Update Date	:	12/17/2024

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