Provider Demographics
NPI:1508280652
Name:GENORITE PHARMACY LLC
Entity Type:Organization
Organization Name:GENORITE PHARMACY LLC
Other - Org Name:GENORITE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HALISTER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:512-351-9160
Mailing Address - Street 1:5200 DAVIS LN
Mailing Address - Street 2:STE 110B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4064
Mailing Address - Country:US
Mailing Address - Phone:512-351-9160
Mailing Address - Fax:512-351-9173
Practice Address - Street 1:5200 DAVIS LN
Practice Address - Street 2:STE 110B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4064
Practice Address - Country:US
Practice Address - Phone:512-351-9160
Practice Address - Fax:512-351-9173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX294833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy