MEDICARE: GENOA HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0003X	Community/Retail Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336S0011X	Specialty Pharmacy

General Provider Information

NPI Number	:	1629219290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENOA HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	707 S GRADY WAY STE 400
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-3246
Country	:	US
Telephone Number	:	877-719-6349
Fax Number	:	877-719-6362

Provider Business Practice Location Address
First Line	:	701 SHADOW LN STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4131
Country	:	US
Telephone Number	:	702-382-4176
Fax Number	:	702-382-4822

Authorized Official
Title or Position	:	SECRETARY
Name	:	KAREN BOHMER
Credential	:
Telephone Number	:	224-231-1833

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	12/24/2024

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Directions to “GENOA HEALTHCARE LLC ” Practice Location

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