| NPI | 1477327674 |
|---|---|
| Doing Business As | GENSOURCE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | SUZY AIVAZIAN President 818-578-4442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2023-11-08 |