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General NPI Number Information
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NPI Number | 1750315719
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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 | 07/10/2006
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 10504 E. ARTESIA BLVD.
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City | BELLFLOWER
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State | CA
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Zip | 90706-6804
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Country | US
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Telephone | 562-920-2300
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Fax | 562-920-2311
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Provider Business Mailing Address
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Address Line | 10504 E. ARTESIA BLVD.
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City | BELLFLOWER
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State | CA
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Zip | 90706-6804
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Country | US
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Telephone | 562-920-2300
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Fax | 562-920-2311
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Authorized Official
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Title or Position | OWNER
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Name | MR. JULLIARD ESGUERRA PARUNGAO
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Credential | PHARMACY TECHNICIAN
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Telephone | 562-920-2300
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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 | PHY 44335
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License Number State | CA
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