1972683373 NPI number — GENVENTURES, INC.

Table of content: (NPI 1972683373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972683373 NPI number — GENVENTURES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENVENTURES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GENESIS FIRSTMED PHARMACY (ADDING GENESIS TO D/B/A)
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972683373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1227 E RUSHOLME ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52803-2459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-421-6366
Provider Business Mailing Address Fax Number:
563-421-6379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1227 E RUSHOLME ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52803-2459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-421-6366
Provider Business Practice Location Address Fax Number:
563-421-6379
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
563-421-6513

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  369 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 369 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336H0001X , with the licence number: 369 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 369 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1615268 . This is a "NABP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0109470 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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