Provider Demographics
NPI:1407958788
Name:GENIVIVA, ALBERT MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:MARK
Last Name:GENIVIVA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:VA PITTSBURGH HEALTHCARE SYSTEM
Mailing Address - Street 2:UNIVERSITY DRIVE C
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15240
Mailing Address - Country:US
Mailing Address - Phone:412-688-6220
Mailing Address - Fax:412-688-6938
Practice Address - Street 1:1548 HEINZ CAMP RD
Practice Address - Street 2:
Practice Address - City:PORTERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16051-3524
Practice Address - Country:US
Practice Address - Phone:724-368-9739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030038L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist