Provider Demographics
NPI:1265776272
Name:GENESIS PHARMACY, INC
Entity type:Organization
Organization Name:GENESIS PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:ONYEMA
Authorized Official - Last Name:OLUWEHUJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-819-7821
Mailing Address - Street 1:15 OLD OAK DR
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3047
Mailing Address - Country:US
Mailing Address - Phone:201-819-7821
Mailing Address - Fax:
Practice Address - Street 1:166 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-7350
Practice Address - Country:US
Practice Address - Phone:201-819-7821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy