# KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kaiser Permanente Longview Kelso Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306893417
- **Authorized official:** ALFRED LYMAN PHARMD, BCPS (EXECUTIVE DIRECTOR, REGIONAL PHARMA)
- **Authorized official phone:** (800) 813-2000

## Contact information

- **Practice address:** 1230 7TH AVE, LONGVIEW, WA 98632-3166
- **Practice address phone:** (360) 636-6226
- **Practice address fax:** (360) 636-6249
- **Mailing address:** 5725 NE 138TH AVE, PORTLAND, OR 97230-3409
- **Mailing address phone:** (503) 261-7980
- **Mailing address fax:** (503) 261-7567

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | CF00002437 | WA | — |
| 3336C0002X | Clinic Pharmacy | RP-0003090-CS | OR | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336M0003X | Managed Care Organization Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 05/27/2006
- **Last updated:** 06/01/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 136676 | — | OR |
| 01 | — | 2108297 | PK | — |
| 05 | — | 6019384 | — | WA |