# GENESIS PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134133069
- **Authorized official:** MR. LUIS CARRASQUILLO (OWNER)
- **Authorized official phone:** (787) 839-5015

## Contact information

- **Practice address:** CARRETERA \#3 KM 123.0, PATILLAS, PR 00723
- **Practice address phone:** (787) 839-5015
- **Mailing address:** PO BOX 986, PATILLAS, PR 00723-0986
- **Mailing address phone:** (787) 839-5015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 07F2072 | PR | Yes |

## Other

- **Enumeration date:** 07/28/2006
- **Last updated:** 09/19/2008