Genoa Healthcare, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

CF57740 Issued in WA

Legal business name

GENOA HEALTHCARE, LLC

Doing business as

Genoa Healthcare

Practice address

325 E Pioneer Ave
Suite B-124
Puyallup, WA 98372-3265

Phone

(253) 770-7000

Fax

(253) 770-7018

NPI assigned

May 3, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ryan Niemeyer

Title

Controller

Phone

(253) 218-0830

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Genoa Healthcare Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335312000000",
    "number": "1396703559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 77030",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554807730",
            "telephone_number": "253-218-0830",
            "fax_number": "253-217-4306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 E PIONEER AVE",
            "address_2": "SUITE B-124",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723265",
            "telephone_number": "253-770-7000",
            "fax_number": "253-770-7018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOA HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2012-04-25",
        "status": "A",
        "authorized_official_last_name": "NIEMEYER",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "253-218-0830"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "WA",
            "license": "CF57740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6027031",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4930601",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genoa Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Adam Clayton Geer
• Gretchen S Gendreau, PSYD
• Blake Patrick Gendron, M.D.
• Genesis Chiropractic Rehabilitation NW Inc
• Nadira Genis, LMP
• Katelyn Rae Genova, PA-C
• Ceara Nicole Gentry, LMT
• Amber Fawn Gentrysouthard, M.S.W, LICSW
• George G. Ghosn D.D.S.,P.S.
• Jaya George, RPH

• Long Term Care Pharmacy in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Long Term Care Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.