# GENOA HEALTHCARE, LLC

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

## Provider details

- **NPI number:** 1073929220
- **Authorized official:** NATASHA HENNESSY (CHIEF PHARMACY OFFICER)
- **Authorized official phone:** (612) 722-4249

## Contact information

- **Practice address:** 975B KINGSVIEW DR, LEBANON, OH 45036-9562
- **Practice address phone:** (412) 931-3131
- **Practice address fax:** (412) 223-5384
- **Mailing address:** PO BOX 77030, MINNEAPOLIS, MN 55480-7730
- **Mailing address phone:** (253) 218-0830
- **Mailing address fax:** (253) 217-4306

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | CLPH.0224343600 | OH | Yes |

## Other

- **Enumeration date:** 07/09/2014
- **Last updated:** 04/21/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2146668 | PK | — |