Healthcare Provider Details

I. General information

NPI: 1679861124
Provider Name (Legal Business Name): GENEPHARMA, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 AVE BARBOSA
CATANO PR
00962-4780
US

IV. Provider business mailing address

S1-2 CALLE 11 VILLAS DE PARANA
SAN JUAN PR
00926-9403
US

V. Phone/Fax

Practice location:
  • Phone: 787-275-4200
  • Fax: 787-275-8167
Mailing address:
  • Phone: 787-692-2449
  • Fax: 787-287-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number13-F-2955
License Number StatePR

VIII. Authorized Official

Name: ANELIESE AYALA
Title or Position: VICE-PRESIDENT
Credential:
Phone: 787-692-2449