Provider Demographics
NPI:1790052975
Name:GENARO, BENJAMIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:GENARO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 BRIDGEPORT LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6783
Mailing Address - Country:US
Mailing Address - Phone:540-840-2279
Mailing Address - Fax:540-283-2544
Practice Address - Street 1:3716 MELROSE AVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-2716
Practice Address - Country:US
Practice Address - Phone:540-283-2552
Practice Address - Fax:540-283-2544
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038984L183500000X
VA0202011488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist