Provider Demographics
NPI:1578654034
Name:GENEVA WOODS PHARMACY, LLC
Entity Type:Organization
Organization Name:GENEVA WOODS PHARMACY, LLC
Other - Org Name:GENEVA WOODS MAT-SU PHARMACY #48551
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR, PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-2751
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:BOX 1075
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:401-765-1500
Mailing Address - Fax:
Practice Address - Street 1:3674 E COUNTRY FIELD CIR
Practice Address - Street 2:STE A
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-5101
Practice Address - Country:US
Practice Address - Phone:907-376-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
AK4143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1021970Medicaid
0227694OtherNCPDP
AK1028535Medicaid
AKK165571OtherMEDICARE - NORIDIAN HEALTHCARE SOLUTIONS
AK0355840002Medicare NSC