Provider Demographics
NPI:1992866065
Name:KIN GENOVESE ENTERPRISES INC
Entity Type:Organization
Organization Name:KIN GENOVESE ENTERPRISES INC
Other - Org Name:SNOUDERS CORNER DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-922-4300
Mailing Address - Street 1:108 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 SOUTH ST
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2214
Practice Address - Country:US
Practice Address - Phone:516-922-4300
Practice Address - Fax:516-922-4908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015691333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00378047Medicaid
3342223OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY00378047Medicaid