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General NPI Number Information
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NPI Number | 1528423670
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Entity Type | Organization
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Legal Business Name | GENESISCARE USA OF FLORIDA LLC
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 8991 BRIGHTON LN STE 200
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-7505
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Country | US
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Telephone | 239-333-1700
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Fax | 239-333-0688
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Provider Business Mailing Address
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Address Line | 1419 SE 8TH TER STE 200
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City | CAPE CORAL
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State | FL
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Zip | 33990-3213
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHADEN MARZOUK
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Credential |
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Telephone | 239-931-7254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH29594
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License Number State | FL
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