Healthcare Provider Details

I. General information

NPI: 1821031642
Provider Name (Legal Business Name): GENESIS MEDICAL EQUIPMENT AND PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G10 CALLE PRINCIPAL URB BARALT
FAJARDO PR
00738-3774
US

IV. Provider business mailing address

PO BOX 887
FAJARDO PR
00738-0887
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-1330
  • Fax: 787-863-1325
Mailing address:
  • Phone: 787-863-1330
  • Fax: 787-863-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number14-F-3060
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. MIRIAM LACEN
Title or Position: PRESIDENT
Credential:
Phone: 787-863-1330