Grandpas Compounding Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

PHY045878 Issued in CA

Legal business name

GRANDPAS COMPOUNDING PHARMACY INC

Practice address

7563 Green Valley Rd
Placerville, CA 95667-3917

Phone

(530) 622-2323

Fax

(530) 622-2011

NPI assigned

Feb 8, 2007

Organization subpart

No

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

Authorized official

Name

Dan Wills

Title

Manager

Phone

(530) 622-2323

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Grandpas Compounding Pharmacy Doing business as

Locations

Practitioners 1

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

• Ronald Lee Keil, PHARMACIST

  • Pharmacist
  • Placerville, CA
  • NPI 1467513903
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448236800000",
    "number": "1689715286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7563 GREEN VALLEY RD",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956673917",
            "telephone_number": "530-622-2323",
            "fax_number": "530-622-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7563 GREEN VALLEY RD",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956673917",
            "telephone_number": "530-622-2323",
            "fax_number": "530-622-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANDPAS COMPOUNDING PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2015-11-23",
        "status": "A",
        "authorized_official_last_name": "WILLS",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "530-622-2323"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY045878",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2155454",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grandpas Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jayle Marie Goucher
• Garth Goudelock
• Mary M Gough, LCSW
• Dylan Grady
• Christina Elizabeth Graham
• Pamela Granick
• Harry Miguel Green, O.D.
• Douglas K. Greenwald, D.D.S.,M.S.
• Kimberly Jean Grissom, NA
• Lisa Groby

• Pharmacy in Placerville, CA
• Providers in Placerville, CA by specialty
• Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; 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.