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Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER ONCOLOGY PHARMACY #104
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN RENOUARD BROWN (VP PHARMACY OPERATIONS AND SERVICES)
(510) 625-2363
Entity
Organization
Contact information
Practice address
3701 BROADWAY FL 3, OAKLAND, CA 94611-5613
(510) 752-6564
Mailing address
1800 HARRISON ST FL 13, OAKLAND, CA 94612-3466
(510) 752-6564
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PHY49905
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5634250
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/06/2009
Last updated
10/20/2020
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