Active NPI
Michael John Genczo, RPH
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Coos Bay, OR
National Provider Identifier
1144522004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- ORRPH-0012481
- Practice address
- 1020 S 1St Ave
Coos Bay, OR 97420 - Phone
- (541) 269-4033
- NPI assigned
- Nov 29, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0012481 | OR | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | ORRPH-0012481 | OR | Primary |
Addresses
Primary practice location
1020 S 1St Ave
Coos Bay, OR 97420
Mailing address
1020 S 1St Ave
Coos Bay, OR 97420
Phone (541) 269-4033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0012481 | OR | MD | Pharmacist |
| ORRPH-0012481 | OR | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493769600000",
"number": "1144522004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 S 1ST AVE",
"city": "COOS BAY",
"state": "OR",
"postal_code": "97420",
"telephone_number": "541-269-4033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 S 1ST AVE",
"city": "COOS BAY",
"state": "OR",
"postal_code": "97420",
"telephone_number": "541-269-4033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENCZO",
"first_name": "MICHAEL",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-11-29",
"last_updated": "2017-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0012481",
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "OR",
"license": "ORRPH-0012481",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coos Bay, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.