Provider Demographics
NPI:1841836954
Name:GENAW, ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GENAW
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 1:26233 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1100
Mailing Address - Country:US
Mailing Address - Phone:586-754-1191
Mailing Address - Fax:586-754-0623
Practice Address - Street 1:26233 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1100
Practice Address - Country:US
Practice Address - Phone:586-754-1191
Practice Address - Fax:586-754-0623
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411953183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist