# KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kaiser Permanente East Interstate Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013963131
- **Authorized official:** STEPHEN SHAWN BARTON (EXECUTIVE DIRECTOR, REVENUE CYCLE)
- **Authorized official phone:** (800) 813-2000

## Contact information

- **Practice address:** 3550 N INTERSTATE AVE, PORTLAND, OR 97227-1196
- **Practice address phone:** (866) 279-6122
- **Practice address fax:** (503) 249-3438
- **Mailing address:** 3550 N INTERSTATE AVE, PORTLAND, OR 97227-1196
- **Mailing address phone:** (866) 279-6122
- **Mailing address fax:** (503) 249-3438

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | — | NULL | — |
| 3336M0003X | Managed Care Organization Pharmacy | RP-0000717-CS | OR | Yes |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 06/23/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 136650 | — | OR |
| 01 | — | 2077391 | PK | — |
| 05 | — | 6019418 | — | WA |