Organization
GENOA HEALTHCARE MINNESOTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE JASON (CONTRACTS ADMINISTRATOR)
(253) 218-0862
Entity
Organization
Contact information
Practice address
1821 UNIVERSITY AVE W, SUITE N-464, SAINT PAUL, MN 55104-2801
(651) 917-4029
(651) 917-4034
Mailing address
PO BOX 673670, DETROIT, MI 48267-0001
(253) 218-0830
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
262961
MN
3336L0003X
Long Term Care Pharmacy
Primary
262961
MN
Other
Enumeration date
01/24/2007
Last updated
09/11/2025
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