Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN NILES 3 PHY 164
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
39400 PASEO PADRE PKWY, FREMONT, CA 94538-2310
(510) 248-3792
(510) 248-3790
Mailing address
1800 HARRISON ST FL 13, OAKLAND, CA 94612-3466
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY39674
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0527587
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA396740
—
CA
Enumeration date
01/08/2007
Last updated
10/21/2020
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