NPIMap

Organization Active NPI

GRX Holdings, LLC

Doing business as Medicap Pharmacy

  • Community/Retail Pharmacy
  • Des Moines, IA
National Provider Identifier
1942452230
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
GRX HOLDINGS, LLC
Doing business as
Medicap Pharmacy
Practice address
2804 Beaver Ave
Des Moines, IA 50310-4038
Phone
(515) 277-3702
Fax
(515) 277-3703
NPI assigned
Oct 17, 2008
Last updated
Dec 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Authorized official

Name
Michael Fuller
Title
President
Phone
(515) 321-7644

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1222 IA
Community/Retail Pharmacy 3336C0003X NU Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

2804 Beaver Ave
Des Moines, IA 50310-4038

Mailing address

2804 Beaver Ave
Des Moines, IA 50310-4038
Phone (515) 277-3702

Other identifiers 1

IdentifierTypeStateIssuer
1623520OtherNCPDP #

Other names 1

  • Medicap Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080520000539 IA Part B Supplier - Mass Immunization (Roster Biller Only) 9931278744 21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Winterset, IA; Waukee, IA; Stuart, IA; Panora, IA; Boone, IA; Norwalk, IA; Newton, IA; Knoxville, IA…
O20100930046076 IA DME Supplier - Pharmacy 9931278744 Practice locations: Des Moines, IA

Other NPIs with the same Medicare PAC ID 19

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 19

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

National Provider Directory

National Provider Directory
Tax ID family
GRX Holdings LLC49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

Organizations that report the same tax identification number in the National Provider Directory.

View all 48

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Karen AcresUrbandale, IA, CCN 165460 Skilled nursing facility Adp of the SNF Aug 1, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Crystal Inc

    dba Karen Acres Healthcare Center

    • Skilled Nursing Facility
    • Urbandale, IA
    • NPI 1295819225

    Adp of the SNF

    CMS ownership

NPI Registry JSON

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

{
    "created_epoch": "1224201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1942452230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2804 BEAVER AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503104038",
            "telephone_number": "515-277-3702",
            "fax_number": "515-277-3703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 BEAVER AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503104038",
            "telephone_number": "515-277-3702",
            "fax_number": "515-277-3703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRX HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-17",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "515-321-7644"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IA",
            "license": "1222",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "1623520",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicap Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medicap Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.