MEDICARE: GENOVESE DRUG STORES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	022867	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	3311432	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	3311432	OTHER	OTHER ID NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376642603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENOVESE DRUG STORES INC

Provider Business Mailing Address
First Line	:	200 NEWBERRY COMMONS
Second Line	:
City	:	ETTERS
State	:	PA
Zip	:	17319-9363
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7326 METROPOLITAN AVE
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-2635
Country	:	US
Telephone Number	:	718-894-0234
Fax Number	:	718-894-0288

Authorized Official
Title or Position	:	MANAGER ONLINE ADJUDICATION
Name	:	JENNIFER ZOREK
Credential	:
Telephone Number	:	717-975-5937

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	02/01/2008

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Directions to “GENOVESE DRUG STORES INC ” Practice Location

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