=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003361114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENVENTURES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2016
-----------------------------------------------------
Last Update Date | 02/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 S COLLEGE AVE
-----------------------------------------------------
City | ALEDO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61231-1630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-582-5151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1803 E KIMBERLY RD
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52807-2027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-421-3302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MARK ROGERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 563-421-3302
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------