Provider Demographics
NPI:1821031642
Name:GENESIS MEDICAL EQUIPMENT AND PHARMACY
Entity Type:Organization
Organization Name:GENESIS MEDICAL EQUIPMENT AND PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LACEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-863-1330
Mailing Address - Street 1:PO BOX 887
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0887
Mailing Address - Country:US
Mailing Address - Phone:787-863-1330
Mailing Address - Fax:787-863-1325
Practice Address - Street 1:G10 CALLE PRINCIPAL
Practice Address - Street 2:URB BARALT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3774
Practice Address - Country:US
Practice Address - Phone:787-863-1330
Practice Address - Fax:787-863-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
PR14-F-30603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4317510001Medicare NSC