Healthcare Provider Details

I. General information

NPI: 1790603512
Provider Name (Legal Business Name): GENESIS PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31946 MISSION TRL STE A1
LAKE ELSINORE CA
92530-4539
US

IV. Provider business mailing address

31946 MISSION TRL STE A1
LAKE ELSINORE CA
92530-4539
US

V. Phone/Fax

Practice location:
  • Phone: 951-245-1373
  • Fax: 877-489-1666
Mailing address:
  • Phone: 951-245-1373
  • Fax: 877-489-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FADY MOSAAD
Title or Position: CEO
Credential: RPH
Phone: 951-245-1373