Provider Demographics
NPI:1982169561
Name:GENESIS PHARMACY CORP
Entity Type:Organization
Organization Name:GENESIS PHARMACY CORP
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FADY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-245-1373
Mailing Address - Street 1:31946 MISSION TRL STE A1
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4539
Mailing Address - Country:US
Mailing Address - Phone:951-245-1373
Mailing Address - Fax:877-489-1666
Practice Address - Street 1:31946 MISSION TRL STE A1
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4539
Practice Address - Country:US
Practice Address - Phone:559-358-5873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy