MEDICARE: STEVEN MICHAEL GENRICH D.PH.

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	183500000X	Pharmacist	7861	AZ
2	183500000X	Pharmacist	8810	WI

General Provider Information

NPI Number	:	1437242708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN MICHAEL GENRICH D.PH.

Provider Business Mailing Address
First Line	:	1307 E LUPINE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-1230
Country	:	US
Telephone Number	:	602-943-3513
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 E VIRGINIA AVE
Second Line	:	SUITE 120
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1206
Country	:	US
Telephone Number	:	602-257-1196
Fax Number	:	602-257-0511

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	07/08/2007

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