Provider Demographics
NPI:1760594121
Name:BEECHER BALLENGER SERVICES, INC
Entity Type:Organization
Organization Name:BEECHER BALLENGER SERVICES, INC
Other - Org Name:GENESYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZZARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-606-6095
Mailing Address - Street 1:1 GENESYS PKWY STE 1430
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8065
Mailing Address - Country:US
Mailing Address - Phone:810-606-6366
Mailing Address - Fax:586-228-4595
Practice Address - Street 1:1 GENESYS PKWY
Practice Address - Street 2:SUITE 1430
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:810-606-6366
Practice Address - Fax:810-606-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301007197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI50-2350104Medicaid