Provider Demographics
NPI:1477954162
Name:GENOVATIONS PHARMACY LLC
Entity Type:Organization
Organization Name:GENOVATIONS PHARMACY LLC
Other - Org Name:GENOVATIONS PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-701-0422
Mailing Address - Street 1:10301 STELLA LINK RD STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5447
Mailing Address - Country:US
Mailing Address - Phone:832-941-0850
Mailing Address - Fax:832-941-0849
Practice Address - Street 1:10301 STELLA LINK RD STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5447
Practice Address - Country:US
Practice Address - Phone:832-941-0850
Practice Address - Fax:832-941-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX299593336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151753OtherPK