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General NPI Number Information
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NPI Number | 1174675599
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Entity Type | Organization
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Legal Business Name | GENESIS PHARMACY
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 1 N BROADWAY ST
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City | DES PLAINES
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State | IL
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Zip | 60016-2335
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Country | US
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Telephone | 847-827-7556
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Fax | 847-827-8263
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Provider Business Mailing Address
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Address Line | 1 N BROADWAY ST
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City | DES PLAINES
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State | IL
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Zip | 60016-2335
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Country | US
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Telephone | 847-827-7556
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Fax | 847-827-8263
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Authorized Official
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Title or Position | OWNER
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Name | HOWARD BLEICHMAN
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Credential | PHARMACIST
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Telephone | 773-622-2331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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