Active NPI
Grane Supply, Inc.
Doing business as Elwyn Rx at Fair Acres
- Long Term Care Pharmacy
- Lima, PA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- License
- PP482618
- Legal business name
- GRANE SUPPLY, INC.
- Doing business as
- Elwyn Rx at Fair Acres
- Practice address
- 340 N Middletown Rd
Lima, PA 19063 - Phone
- (610) 891-5783
- Fax
- (610) 891-5860
- NPI assigned
- Nov 30, 2015
- Last updated
- Jul 27, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Robert Charles Funderlich
- Title
- Chief Financial Officer
- Phone
- (412) 449-0690
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Long Term Care Pharmacy | 3336L0003X | PP482618 | PA | Primary |
Addresses
Primary practice location
340 N Middletown Rd
Lima, PA 19063
Mailing address
105 Gamma Drive
Suite 100
Pittsburgh, PA 15238
Phone (412) 449-0680
Other names 1
- Elwyn Rx at Fair Acres
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210921002597 | PA | Part B Supplier - Mass Immunization (Roster Biller Only) | 2668592379 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lima, PA; Pittsburgh, PA; West Chester, PA |
| O20250723002431 | PA | DME Supplier - Pharmacy | 2668592379 | Practice locations: Media, PA |
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Grane Supply
- Long Term Care Pharmacy
- Pittsburgh, PA
- NPI 1376520676
2668592379
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Grane Supply
- Long Term Care Pharmacy
- Pittsburgh, PA
- NPI 1376520676
O20210921002597
-
dba GraneRx
- Long Term Care Pharmacy
- West Chester, PA
- NPI 1962867077
O20210921002597
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Grane Supply, Inc | Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Y Clinical Lab
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
Locations
3070 McCann Farm Dr
Ste 101
Garnet Valley, PA 19060
Phone (610) 545-6040
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Aurora, CO
- NPI 1174251441
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1448841600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1627344000000",
"number": "1255705349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 GAMMA DRIVE",
"address_2": "SUITE 100",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "15238",
"telephone_number": "412-449-0680",
"fax_number": "129-685-8004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 N MIDDLETOWN RD",
"city": "LIMA",
"state": "PA",
"postal_code": "19063",
"telephone_number": "610-891-5783",
"fax_number": "610-891-5860"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GRANE SUPPLY, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2015-11-30",
"last_updated": "2021-07-27",
"certification_date": "2021-07-27",
"status": "A",
"authorized_official_last_name": "FUNDERLICH",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "CHARLES",
"authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "412-449-0690",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "PA",
"license": "PP482618",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Elwyn Rx at Fair Acres",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lima, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.