Provider Demographics
NPI:1629007687
Name:GENUARDI'S FAMILY MARKETS LP GFM
Entity Type:Organization
Organization Name:GENUARDI'S FAMILY MARKETS LP GFM
Other - Org Name:GENUARDI'S PHARMACY #3012
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE PLAN SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-869-3602
Mailing Address - Street 1:20427 N 27TH AVE
Mailing Address - Street 2:MAIL STOP 4551
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3241
Mailing Address - Country:US
Mailing Address - Phone:623-869-3602
Mailing Address - Fax:623-869-1924
Practice Address - Street 1:1844 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1504
Practice Address - Country:US
Practice Address - Phone:215-948-8016
Practice Address - Fax:215-948-8003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFEWAY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481514332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3985201OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA0016820210005Medicaid
PAPHC085Medicare PIN
3985201OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA0016820210005Medicaid