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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	026942	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3340332	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1861591117
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	:	717-761-2633
Fax Number	:	717-975-8659

Provider Business Practice Location Address
First Line	:	195 8TH AVENUE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-3302
Country	:	US
Telephone Number	:	212-929-6915
Fax Number	:

Authorized Official
Title or Position	:	SR MANAGER PROVIDER ENROLLMENT
Name	:	JENNIFER ZOREK
Credential	:
Telephone Number	:	717-975-5937

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	11/25/2014

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