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NPI Code Detail

MEDICARE: GENOA HEALTHCARE LLC

MEDICARE: GENOA HEALTHCARE LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy
23336L0003XLong Term Care Pharmacy

General Provider Information

NPI Number : 1316353832
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 : 253-218-0830
Fax Number : 253-217-4306
Provider Business Practice Location Address
First Line : 3001 N 33RD AVE
Second Line : ROOM 210
City : PHOENIX
State : AZ
Zip : 85017-5202
Country : US
Telephone Number : 480-422-3283
Fax Number : 480-304-3210
Authorized Official
Title or Position : SECRETARY
Name : KAREN BOHMER
Credential :
Telephone Number : 224-231-1833
Provider Enumeration Date : 07/03/2014
Last Update Date : 12/26/2024

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