Grane Supply, Inc.
Organization Active NPI Long Term Care Pharmacy · Lima, PA
NPI 1255705349 · NPPES record last updated Jul 27, 2021
Key facts
- NPI
- 1255705349
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Pharmacy 3336L0003X
- License
- PP482618 (PA)
- Legal business name
- GRANE SUPPLY, INC.
- Practice address
- 340 N Middletown Rd
Lima, PA 19063 - Phone
- (610) 891-5783
- Fax
- (610) 891-5860
- NPI assigned
- Nov 30, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Robert Charles Funderlich
- Title
- Chief Financial Officer
- Phone
- (412) 449-0690
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 3
Practitioners 1
-
Jacob Heiling, PHARMD
Laboratory certificates & supplier records
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA
Medicare enrollment records
| 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 |
National Provider Directory
- Tax ID family
- Grane Supply Clinical L
Locations
105 Gamma Dr
Pittsburgh, PA 15238
Phone (412) 449-0680
550 E Union St
Ste B
West Chester, PA 19382
Phone (610) 918-4740
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Long Term Care Pharmacy | 3336L0003X | PP482618 | PA | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PP482618 | Other | PA | BOARD OF PHARMACY |
| 1008270470004 | Medicaid | PA |
Other names
- Elwyn Rx at Fair Acres
Other providers in Lima, PA
- Dominique Butz
- Albert Chu
- County of Delaware
- Lauren Ellis
- Lima Gerontology Associates LLP
- Mirmont Treatment Center
- Megan Leigh Myerson
All providers in Lima, PA · Long Term Care Pharmacy in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.