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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
3807 CLAIRMONT RD, ATLANTA, GA 30341-4911
(770) 457-5867
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
3336C0003X
Community/Retail Pharmacy
3336L0003X
Long Term Care Pharmacy
Primary
PHRE010080
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2147832
PK
Enumeration date
09/02/2014
Last updated
06/28/2022
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