Genoa Healthcare LLC
Pharmacy, Long Term Care Pharmacy in Bridgeport, WV. Organization (NPI-2).
NPI number1114642014
StatusActive
Last updated in NPPESJan 16, 2024
Details
- NPI
- 1114642014
- Entity type
- Organization (NPI-2)
- Legal business name
- Genoa Healthcare LLC
- Organization subpart
- No
- Enumeration date
- Oct 4, 2022
- Certification date
- Jan 16, 2024
- Last updated
- Jan 16, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336L0003X | Pharmacy, Long Term Care Pharmacy | – | – | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – | |
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – |
Practice location
120 Professional Pl Rm PBridgeport, WV 26330-4599
Phone 681-456-6195 · Fax 812-853-9086
Mailing address
707 S Grady Way Ste 400Renton, WA 98057-3246
Phone 253-218-0830 · Fax 253-217-4306
Authorized official
Karen Bohmer
Secretary
2242311833
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