Provider Demographics
NPI:1689866089
Name:GENUINE CARE PHARMACY INC
Entity Type:Organization
Organization Name:GENUINE CARE PHARMACY INC
Other - Org Name:GENUINE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:RECKTENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:501-749-9136
Mailing Address - Street 1:7337 HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:GASSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72635-8636
Mailing Address - Country:US
Mailing Address - Phone:870-435-5757
Mailing Address - Fax:
Practice Address - Street 1:7337 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:GASSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72635-8636
Practice Address - Country:US
Practice Address - Phone:870-435-5757
Practice Address - Fax:870-435-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR203383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165230407Medicaid
1989795OtherPK
1989795OtherPK