Provider Demographics
NPI:1265659361
Name:GENUARDI'S FAMILY MARKETS LP (GFM)
Entity Type:Organization
Organization Name:GENUARDI'S FAMILY MARKETS LP (GFM)
Other - Org Name:GENUARDIS PHARMACY #1007
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANG CARE PLAN SPEC
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:623-869-3524
Mailing Address - Street 1:20427 N 27TH AVE # MS 4551
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 S HENDERSON RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2408
Practice Address - Country:US
Practice Address - Phone:610-209-1031
Practice Address - Fax:610-290-1018
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFEWAY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
PAPP4817103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007518700027Medicaid
3988168OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA1007518700027Medicaid
PA4208880021Medicare NSC
PAPHC085Medicare PIN