Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN MOB 1 PHY 511
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
1425 S MAIN ST FL 1, WALNUT CREEK, CA 94596-5318
(925) 295-4464
(925) 295-4462
Mailing address
1800 HARRISON ST FL 13, OAKLAND, CA 94612-3466
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY40642
CA
3336I0012X
Institutional Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0549747
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHB406420
—
CA
Enumeration date
01/08/2007
Last updated
10/07/2020
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