Healthcare Provider Details

I. General information

NPI: 1295947273
Provider Name (Legal Business Name): JOHN ROBERT GENOVESE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COURT ST
KEENE NH
03431-1718
US

IV. Provider business mailing address

47 KATIE LN
SWANZEY NH
03446-5607
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-6548
  • Fax:
Mailing address:
  • Phone: 603-357-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2209
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: