Provider Demographics
NPI:1457380412
Name:GENUARDI'S FAMILY MARKETS LP GFM
Entity type:Organization
Organization Name:GENUARDI'S FAMILY MARKETS LP GFM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE PLAN SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-869-3602
Mailing Address - Street 1:20427 N 27TH AVE
Mailing Address - Street 2:MAIL STOP 4551
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3241
Mailing Address - Country:US
Mailing Address - Phone:623-869-3602
Mailing Address - Fax:623-869-1924
Practice Address - Street 1:950 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2847
Practice Address - Country:US
Practice Address - Phone:610-604-0237
Practice Address - Fax:610-604-0723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAFEWAY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481157333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3980477OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PA01914968Medicaid
PA01914968Medicaid
PAPHC016Medicare PIN
3980477OtherOTHER ID NUMBER-COMMERCIAL NUMBER