Provider Demographics
NPI:1396178919
Name:GENESIS PHARMACY CORP
Entity Type:Organization
Organization Name:GENESIS PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIESER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-261-2660
Mailing Address - Street 1:8150 SW 8TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4263
Mailing Address - Country:US
Mailing Address - Phone:305-261-2660
Mailing Address - Fax:305-261-2660
Practice Address - Street 1:8150 SW 8TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4263
Practice Address - Country:US
Practice Address - Phone:305-261-2660
Practice Address - Fax:305-261-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH26968333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy