Provider Demographics
NPI:1902368079
Name:GNRX PHARMACY INC
Entity Type:Organization
Organization Name:GNRX PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTOANELA IOANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDRU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-422-9193
Mailing Address - Street 1:2440 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4334
Mailing Address - Country:US
Mailing Address - Phone:310-868-8770
Mailing Address - Fax:424-210-5090
Practice Address - Street 1:2440 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-4334
Practice Address - Country:US
Practice Address - Phone:310-868-8770
Practice Address - Fax:424-210-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA199ETI5PMedicaid