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
1330 W 26TH ST, ERIE, PA 16508-1402
(814) 651-9098
(814) 459-9254
Mailing address
PO BOX 77030, MINNEAPOLIS, MN 55480-7730
(253) 218-0830
(253) 217-4306
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PP482319
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137959
PK
—
Enumeration date
12/07/2012
Last updated
04/26/2021
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