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NPI Code Detail

MEDICARE: GENOA HEALTHCARE, LLC

MEDICARE: GENOA HEALTHCARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacy
43336L0003XLong Term Care Pharmacy58013565IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11480057OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851496160
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENOA HEALTHCARE, LLC
Provider Business Mailing Address
First Line : PO BOX 77030
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55480-7730
Country : US
Telephone Number : 253-218-0830
Fax Number : 253-217-4306
Provider Business Practice Location Address
First Line : 526 W STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61101-1214
Country : US
Telephone Number : 815-962-8192
Fax Number : 815-962-5703
Authorized Official
Title or Position : CHIEF PHARMACY OFFICER
Name : NATASHA HENNESSY
Credential :
Telephone Number : 612-722-4249
Provider Enumeration Date : 09/13/2006
Last Update Date : 04/27/2021

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Directions to “GENOA HEALTHCARE, LLC ” Practice Location

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