MEDICARE: GENESIS SPECIALTY PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	3336S0011X	Specialty Pharmacy

General Provider Information

NPI Number	:	1184284929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS SPECIALTY PHARMACY, LLC

Provider Business Mailing Address
First Line	:	2951 MAPLE AVE
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-1406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 TAYLOR ST STE B
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-2010
Country	:	US
Telephone Number	:	740-454-5667
Fax Number	:

Authorized Official
Title or Position	:	CSO
Name	:	MICHAEL NORMAN
Credential	:
Telephone Number	:	740-454-4773

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	12/02/2024

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Directions to “GENESIS SPECIALTY PHARMACY, LLC ” Practice Location

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