Organization
GENOA HEALTHCARE OF KY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MARTYN (PRESIDENT)
(253) 639-5088
Entity
Organization
Contact information
Practice address
1100 WALNUT ST, OWENSBORO, KY 42301-2956
(270) 689-0002
(270) 689-0079
Mailing address
510 E MAIN ST, AUBURN, WA 98002-5502
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
P07131
KY
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1829641
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
09/11/2025
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