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Organization
GENOA HEALTHCARE, LLC
Active
Organization
GENOA HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH DOUGLAS (CEO)
(815) 404-4871
Entity
Organization
Contact information
Practice address
940 GA HIGHWAY 96 STE 200A, WARNER ROBINS, GA 31088-2584
(478) 352-0916
(478) 987-2782
Mailing address
707 S GRADY WAY STE 700, RENTON, WA 98057-3243
(253) 218-0830
(253) 217-4306
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
PHRE010142
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153101
PK
—
Enumeration date
03/06/2015
Last updated
09/15/2022
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