Provider Demographics
NPI:1760093744
Name:GENCA, MICAELA LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:LEE
Last Name:GENCA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2233
Mailing Address - Country:US
Mailing Address - Phone:609-458-2026
Mailing Address - Fax:
Practice Address - Street 1:1015 N MAIN RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-2538
Practice Address - Country:US
Practice Address - Phone:856-691-1465
Practice Address - Fax:856-696-3215
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03910000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist