Provider Demographics
NPI:1891846440
Name:GENIUS, GWEN M (RPH)
Entity Type:Individual
Prefix:MS
First Name:GWEN
Middle Name:M
Last Name:GENIUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 CHAPIN CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-6647
Mailing Address - Country:US
Mailing Address - Phone:817-244-5694
Mailing Address - Fax:
Practice Address - Street 1:3605 CHAPIN CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-6647
Practice Address - Country:US
Practice Address - Phone:817-244-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist