Provider Demographics
NPI:1992249254
Name:GENOVESE, RICHARD LAWRENCE (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:GENOVESE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 CORKHILL RD APT 803A
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3487
Mailing Address - Country:US
Mailing Address - Phone:216-577-6211
Mailing Address - Fax:
Practice Address - Street 1:668 CORKHILL RD APT 803A
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3487
Practice Address - Country:US
Practice Address - Phone:216-577-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032087521835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care