Provider Demographics
NPI:1306168521
Name:GENOLA, CHARLES H
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:GENOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1407
Mailing Address - Country:US
Mailing Address - Phone:913-381-5883
Mailing Address - Fax:913-381-2707
Practice Address - Street 1:9401 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1407
Practice Address - Country:US
Practice Address - Phone:913-381-5883
Practice Address - Fax:913-381-2707
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10216183500000X
WY2193183500000X
MO45297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist