Organization
GENOA HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATASHA HENNESSY (CHIEF PHARMACY OFFICER)
(612) 722-4249
Entity
Organization
Contact information
Practice address
445 S LANDMARK AVE STE P, BLOOMINGTON, IN 47403-5004
(253) 218-0830
(253) 217-4306
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2169084
PK
—
Enumeration date
02/03/2017
Last updated
04/26/2021
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