Organization
GENESIS PHARMACY CORP
Active
Organization
GENESIS PHARMACY CORP
Active
Other names
ENOVA CARE PHARMACY, The Medicine Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
FADY MOSAAD (CEO)
(951) 245-1373
Entity
Organization
Contact information
Practice address
31946 MISSION TRL STE A1, LAKE ELSINORE, CA 92530-4539
(559) 358-5873
Mailing address
31946 MISSION TRL STE A1, LAKE ELSINORE, CA 92530-4539
(951) 245-1373
(877) 489-1666
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982169561
—
CA
01
—
PHY57029
PHARMACY PERMIT
CA
Enumeration date
02/07/2019
Last updated
07/08/2026
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