Provider Demographics
NPI:1902026727
Name:GENEPHARMA CORP.
Entity Type:Organization
Organization Name:GENEPHARMA CORP.
Other - Org Name:FARMACIAS PLAZA 17
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANELIESE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-692-2449
Mailing Address - Street 1:PO BOX 260310
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-692-2449
Mailing Address - Fax:787-740-3666
Practice Address - Street 1:AVE. BORINQUEN #2263, BARRIO OBRERO, SANTURCE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915
Practice Address - Country:US
Practice Address - Phone:787-305-2020
Practice Address - Fax:787-689-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18-F33983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4015308OtherNCPDP PROVIDER IDENTIFICATION NUMBER