Organization
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Active
Other names
Kaiser Permanente Westside Medical Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ALFRED E. LYMAN JR. PHARMD., BCPS (EXEC. DIRECTOR PHARMACY SERVICES)
(503) 261-7980
Entity
Organization
Contact information
Practice address
2875 NW STUCKI AVE, HILLSBORO, OR 97124-5806
(866) 280-0511
(971) 310-3351
Mailing address
5725 NE 138TH AVE, PORTLAND, OR 97230-3409
(866) 280-0511
(971) 310-3351
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
0002241
OR
3336M0003X
Managed Care Organization Pharmacy
0002771
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2038157
—
WA
01
—
3844708
NCPDP
—
05
—
50065832
—
OR
01
—
RP-0002771-CS
BOP LICENSE
OR
Enumeration date
04/23/2013
Last updated
03/07/2023
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