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General NPI Number Information
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NPI Number | 1649385675
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Entity Type | Organization
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Legal Business Name | GENOA HEALTHCARE OF KY LLC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1100 WALNUT ST
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City | OWENSBORO
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State | KY
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Zip | 42301-2956
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Country | US
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Telephone | 270-689-0002
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Fax | 270-689-0079
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Provider Business Mailing Address
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Address Line | 510 E MAIN ST
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City | AUBURN
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State | WA
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Zip | 98002-5502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN MARTYN
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Credential |
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Telephone | 253-639-5088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07131
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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