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
23 WARREN ST SE, ATLANTA, GA 30317-2201
(404) 508-6449
(404) 378-9298
Mailing address
PO BOX 77030, MINNEAPOLIS, MN 55480-7730
(253) 218-0830
(253) 217-4306
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHRE010079
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147833
PK
—
Enumeration date
09/02/2014
Last updated
04/27/2021
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