# KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

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

## Provider details

- **NPI number:** 1790113371
- **Authorized official:** STEVE LOGAN RPH (EXEC. DIRECTOR PHARMACY SERVICES)
- **Authorized official phone:** (503) 261-7566

## Contact information

- **Practice address:** 1230 7TH AVE., LONGVIEW, WA 98682
- **Practice address phone:** (866) 279-8943
- **Practice address fax:** (360) 636-6271
- **Mailing address:** 5725 NE 138TH AVE., PORTLAND, OR 97230-3409
- **Mailing address phone:** (503) 261-2166
- **Mailing address fax:** (503) 261-2166

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | PHAR.CF.60362983 | WA | Yes |
| 3336M0003X | Managed Care Organization Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 10/17/2013
- **Last updated:** 06/01/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6019384 | — | WA |
| 01 | — | PHAR.CF.60362983WA | BOP LICENSE | WA |