Organization
GENOA HEALTHCARE OF FLORIDA, LLC
Active
Other names
Genoa Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN NIEMEYER (CONTROLLER)
(253) 218-0830
Entity
Organization
Contact information
Practice address
1437 S BELCHER RD, CLEARWATER, FL 33764-2829
(727) 533-9073
(727) 533-9184
Mailing address
PO BOX 77030, MINNEAPOLIS, MN 55480-7730
(253) 218-0830
(253) 217-4306
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PH22102
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031630000
—
FL
01
—
1020356
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
PH22102
BOP LICENSE
FL
Enumeration date
09/21/2006
Last updated
03/07/2023
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