Provider Demographics
NPI:1396564878
Name:GENOVESE, HALEY (PHARMD)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1602
Mailing Address - Country:US
Mailing Address - Phone:860-817-6326
Mailing Address - Fax:
Practice Address - Street 1:240 CHASE AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-2237
Practice Address - Country:US
Practice Address - Phone:203-756-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist