1760432173 NPI number — GRANDVIEW PHARMACY, INC.

Table of content: (NPI 1760432173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760432173 NPI number — GRANDVIEW PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRANDVIEW PHARMACY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GRANDVIEW MEDICAL EQUIPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760432173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/11/2017
NPI Reactivation Date:
12/27/2017

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
474 SOUTHPOINT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSBURG
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46112-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-827-7575
Provider Business Mailing Address Fax Number:
800-228-0844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2330 N PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONNERSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47331-2904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-827-7575
Provider Business Practice Location Address Fax Number:
800-228-0844
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELDRIDGE
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
317-858-6600

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  60002003A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , with the licence number: 60002003A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100295600 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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