Provider Demographics
NPI:1093038945
Name:GENESIS RX LLC
Entity Type:Organization
Organization Name:GENESIS RX LLC
Other - Org Name:GENESIS RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-703-1895
Mailing Address - Street 1:1485 FM 1960 BYPASS RD E
Mailing Address - Street 2:STE # 370
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3964
Mailing Address - Country:US
Mailing Address - Phone:888-474-4832
Mailing Address - Fax:210-468-8267
Practice Address - Street 1:1485 FM 1960 BYPASS RD E STE 370
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3964
Practice Address - Country:US
Practice Address - Phone:888-474-4832
Practice Address - Fax:210-468-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX268803336C0003X
TX3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124084OtherPK
2124084OtherPK