Provider Demographics
NPI:1598330649
Name:GENSON, RICHARD WILLIAM III
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:GENSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12031 SARAH
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MI
Mailing Address - Zip Code:48457-8907
Mailing Address - Country:US
Mailing Address - Phone:810-247-0258
Mailing Address - Fax:
Practice Address - Street 1:309 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1113
Practice Address - Country:US
Practice Address - Phone:989-652-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303012910183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician