Healthcare Provider Details

I. General information

NPI: 1831558816
Provider Name (Legal Business Name): GENESEE RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 GENESEE ST
UTICA NY
13502-5635
US

IV. Provider business mailing address

1900 GENESEE ST
UTICA NY
13502-5635
US

V. Phone/Fax

Practice location:
  • Phone: 315-765-8800
  • Fax: 315-765-8801
Mailing address:
  • Phone: 315-765-8800
  • Fax: 315-765-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number034365
License Number StateNY

VIII. Authorized Official

Name: HASMUKHKUMAR PATEL
Title or Position: SECRETARY
Credential:
Phone: 315-765-8800