Provider Demographics
NPI:1518141944
Name:GENESIS RESPIRATORY SERVICES INC
Entity Type:Organization
Organization Name:GENESIS RESPIRATORY SERVICES INC
Other - Org Name:GENESIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-354-4363
Mailing Address - Street 1:4132 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5511
Mailing Address - Country:US
Mailing Address - Phone:740-354-4363
Mailing Address - Fax:740-353-1938
Practice Address - Street 1:4132 GALLIA ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5511
Practice Address - Country:US
Practice Address - Phone:740-354-4363
Practice Address - Fax:740-353-1938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS RESPIRATORY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-20
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH333600000X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5400256300Medicaid
OH2184587Medicaid