Provider Demographics
NPI:1942230131
Name:GENEVA WOODS PHARMACY WASHINGTON, LLC
Entity Type:Organization
Organization Name:GENEVA WOODS PHARMACY WASHINGTON, LLC
Other - Org Name:GENEVA WOODS PHARMACY 48548
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:BOX 1075
Mailing Address - Street 2:1 CVS DRIVE
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 1:6600 NE 112TH CT
Practice Address - Street 2:SUITE 103
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5494
Practice Address - Country:US
Practice Address - Phone:360-694-7377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
WAPHAR.CF.605249733336I0012X, 3336L0003X, 3336M0002X, 3336L0003X
WA603-447-258332B00000X
WACF000571523336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4929557OtherNCPDP NUMBER
WAP01704987OtherMEDICARE RAILROAD
G8938020OtherMEDICARE PART B
OR227930Medicaid
WA2042983Medicaid
G8938020OtherMEDICARE PART B
4929557OtherNCPDP NUMBER
WAP01704987OtherMEDICARE RAILROAD