Provider Demographics
NPI:1821612441
Name:GENESIS APOTHECARY INC
Entity Type:Organization
Organization Name:GENESIS APOTHECARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-203-7829
Mailing Address - Street 1:101 SOUTHWESTERN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3548
Mailing Address - Country:US
Mailing Address - Phone:281-203-7829
Mailing Address - Fax:713-583-1802
Practice Address - Street 1:101 SOUTHWESTERN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3548
Practice Address - Country:US
Practice Address - Phone:281-203-7829
Practice Address - Fax:713-583-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149677Medicaid