# GENOA HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568158707
- **Authorized official:** KAREN BOHMER (SECRETARY)
- **Authorized official phone:** (952) 936-1300

## Contact information

- **Practice address:** 636 ST ANNE STREET, SUITE 100, ROOM P, RAPID CITY, SD 57701
- **Practice address phone:** (605) 646-6039
- **Practice address fax:** (605) 705-2760
- **Mailing address:** 707 S GRADY WAY STE 400, RENTON, WA 98057-3246
- **Mailing address phone:** (253) 218-0830
- **Mailing address fax:** (253) 217-4306

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 04/12/2023
- **Last updated:** 12/28/2023