Grassroots Pharmacy PLLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P07798 Issued in KY

Legal business name

GRASSROOTS PHARMACY PLLC

Practice address

2304 Sir Barton Way Ste 195
Lexington, KY 40509-2284

Phone

(859) 227-0707

Fax

(859) 263-1684

NPI assigned

Oct 17, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shelley Roberts, RPHNPI 1700309853

Title

Owner/Pic/Ao

Phone

(859) 227-0707

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Grassroots Pharmacy, PLLC Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shelley Diane Roberts, PHARMD

  • Pharmacist
  • Lexington, KY
  • NPI 1700309853
  NPD Authorized official
• Pavel Conovalciuc, MD

  • Family Medicine Physician
  • Spokane Valley, WA
  • NPI 1720017080
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1336690122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3121 ALTHORP WAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405092423",
            "telephone_number": "859-227-0707",
            "fax_number": "859-263-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 SIR BARTON WAY STE 195",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405092284",
            "telephone_number": "859-227-0707",
            "fax_number": "859-263-1684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRASSROOTS PHARMACY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "OWNER/PIC/AO",
        "authorized_official_telephone_number": "859-227-0707",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "KY",
            "license": "P07798",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2165793",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grassroots Pharmacy, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Morgan Rose Grantham, APRN
• William Jeffrey Grantham, M.D.
• Daniel A Grantz, PHARMD
• Kate McAlister Grap, APRN
• Grassroots Clinical Services
• Grateful Doc LLC
• Stephen Tyler Graul, DMD
• Timothy McDowell Graven III
• Barbara Lindsey Graves, LCSW
• Carrie Dunaway Graves, APRN

• Community/Retail Pharmacy in Lexington, KY
• Providers in Lexington, KY by specialty
• Community/Retail Pharmacy in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.