Provider Demographics
NPI:1184846339
Name:GENIS ENTERPRISE INC.
Entity Type:Organization
Organization Name:GENIS ENTERPRISE INC.
Other - Org Name:JAYS PHARMACY & LIQUOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-450-1900
Mailing Address - Street 1:1550 N MANNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:STONE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60165-1117
Mailing Address - Country:US
Mailing Address - Phone:708-450-1900
Mailing Address - Fax:708-450-1904
Practice Address - Street 1:1550 N MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:STONE PARK
Practice Address - State:IL
Practice Address - Zip Code:60165-1117
Practice Address - Country:US
Practice Address - Phone:708-450-1900
Practice Address - Fax:708-450-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
5926110001Medicare NSC