MEDICARE: GENUARDI'S FAMILY MARKETS LP GFM

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	332B00000X	Durable Medical Equipment & Medical Supplies	PP412865	PA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3981037	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366471328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENUARDI'S FAMILY MARKETS LP GFM

Provider Business Mailing Address
First Line	:	20427 N 27TH AVE
Second Line	:	MAIL STOP 4551
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3241
Country	:	US
Telephone Number	:	623-869-3602
Fax Number	:	623-869-1924

Provider Business Practice Location Address
First Line	:	107 S MAIN ST
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-2832
Country	:	US
Telephone Number	:	215-699-7555
Fax Number	:	215-699-6792

Authorized Official
Title or Position	:	MANAGED CARE PLAN SPECIALIST
Name	:	DELLA DELLA
Credential	:
Telephone Number	:	623-869-3602

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	10/22/2012

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