Provider Demographics
NPI:1801415641
Name:ALCALA, GENESEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:GENESEE
Middle Name:
Last Name:ALCALA
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 1:3997 UNIVERSITY DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-3172
Mailing Address - Country:US
Mailing Address - Phone:256-534-2785
Mailing Address - Fax:
Practice Address - Street 1:3997 UNIVERSITY DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-3172
Practice Address - Country:US
Practice Address - Phone:256-534-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-12
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL21241OtherALABAMA BOARD OF PHARMACY