# KAISER FOUNDATION HEALTH PLAN NORTHWEST

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kaiser Fisher's Landing Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568418069
- **Authorized official:** JOYCE HUMPHREY R.PH. (SUPERVISOR)
- **Authorized official phone:** (360) 735-5274

## Contact information

- **Practice address:** 16703 SE MCGILLIVRAY BLVD, VANCOUVER, WA 98683-4300
- **Practice address phone:** (360) 735-5645
- **Practice address fax:** (360) 735-5646
- **Mailing address:** 16703 SE MCGILLIVRAY BLVD, VANCOUVER, WA 98683-4300
- **Mailing address phone:** (360) 735-5645
- **Mailing address fax:** (360) 735-5646

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | 05462 | WA | Yes |
| 3336M0003X | Managed Care Organization Pharmacy | 05462 | WA | — |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 06/01/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 138151 | — | OR |
| 01 | — | 4925383 | NCPDP | WA |
| 05 | — | 6019483 | — | WA |