Organization
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Active
Other names
Kaiser Permanente Gateway Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE LOGAN RPH (EXEC. DIRECTOR, PHARMACY SERVICES)
(503) 261-7566
Entity
Organization
Contact information
Practice address
1700 NE 102ND AVE., PORTLAND, OR 97220
(866) 279-4581
(971) 229-6861
Mailing address
5725 NE 138TH AVE., PORTLAND, OR 97230-3409
(503) 261-2166
(503) 261-2166
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
RP-0002839-CS
OR
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500664821
—
OR
01
—
RP-0002839-CS
BOP LICENSE
OR
Enumeration date
10/02/2013
Last updated
06/01/2021
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