Healthcare Provider Details

I. General information

NPI: 1902368079
Provider Name (Legal Business Name): GNRX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 S WESTERN AVE
SAN PEDRO CA
90732-4334
US

IV. Provider business mailing address

2440 S WESTERN AVE
SAN PEDRO CA
90732-4334
US

V. Phone/Fax

Practice location:
  • Phone: 310-868-8770
  • Fax: 424-210-5090
Mailing address:
  • Phone: 310-868-8770
  • Fax: 424-210-5090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. ANTOANELA IOANA ALEXANDRU
Title or Position: PHARMACIST-IN-CHARGE AND CEO
Credential:
Phone: 805-422-9193