MEDICARE: MATTHEW A GENIN B.S., R.PH.

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	183500000X	Pharmacist	RP0006332	WV

General Provider Information

NPI Number	:	1437461720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW A GENIN B.S., R.PH.

Provider Business Mailing Address
First Line	:	4 GARTON PLZ
Second Line	:
City	:	WESTON
State	:	WV
Zip	:	26452-2129
Country	:	US
Telephone Number	:	304-269-3737
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 GARTON PLZ
Second Line	:
City	:	WESTON
State	:	WV
Zip	:	26452-2129
Country	:	US
Telephone Number	:	304-269-3737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	07/02/2010

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