Provider Demographics
NPI:1891741955
Name:GENVENTURES, INC
Entity Type:Organization
Organization Name:GENVENTURES, INC
Other - Org Name:GENESIS FIRSTMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-421-4176
Mailing Address - Street 1:1227 E RUSHOLME ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2459
Mailing Address - Country:US
Mailing Address - Phone:563-451-6513
Mailing Address - Fax:
Practice Address - Street 1:1227 E RUSHOLME ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2459
Practice Address - Country:US
Practice Address - Phone:563-421-6366
Practice Address - Fax:563-421-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA10193336H0001X, 3336L0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45247OtherWELLMARK
IA0109470Medicaid
IL=========003Medicaid
IA45247OtherWELLMARK
25041Medicare Oscar/Certification