Provider Demographics
NPI:1174675599
Name:GENESIS PHARMACY
Entity Type:Organization
Organization Name:GENESIS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:773-622-2331
Mailing Address - Street 1:1 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2335
Mailing Address - Country:US
Mailing Address - Phone:847-827-7556
Mailing Address - Fax:847-827-8263
Practice Address - Street 1:1 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2335
Practice Address - Country:US
Practice Address - Phone:847-827-7556
Practice Address - Fax:847-827-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy