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General NPI Number Information
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NPI Number | 1396635660
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Entity Type | Organization
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Legal Business Name | GENOA HEALTHCARE LLC
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 686 LESTER ST STE P
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-5025
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Country | US
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Telephone | 573-772-7225
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Fax | 573-298-4750
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Provider Business Mailing Address
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Address Line | 707 S GRADY WAY STE 400
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City | RENTON
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State | WA
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Zip | 98057-3201
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Country | US
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Telephone | 253-218-0830
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Fax | 253-217-4306
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Authorized Official
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Title or Position | SECRETARY
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Name | KAREN BOHMER
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Credential |
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Telephone | 224-231-1833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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