Provider Demographics
NPI:1518054576
Name:GENCO, ANTOINETTE JOSEPHINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:JOSEPHINE
Last Name:GENCO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 THOMAS FOX DR W
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2937
Mailing Address - Country:US
Mailing Address - Phone:716-695-5894
Mailing Address - Fax:
Practice Address - Street 1:833 THOMAS FOX DR W
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2937
Practice Address - Country:US
Practice Address - Phone:716-695-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020-039602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist