MEDICARE: MRS. ANTOINETTE JOSEPHINE GENCO 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	020-039602	NY

General Provider Information

NPI Number	:	1518054576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANTOINETTE JOSEPHINE GENCO R.PH.

Provider Business Mailing Address
First Line	:	833 THOMAS FOX DR W
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2937
Country	:	US
Telephone Number	:	716-695-5894
Fax Number	:

Provider Business Practice Location Address
First Line	:	833 THOMAS FOX DR W
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2937
Country	:	US
Telephone Number	:	716-695-5894
Fax Number	:

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	12/29/2010

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