Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN 2 WEST PHARMACY 582
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM PERRY FLOWERS (VP ACUTE TRANSITIONAL CARE)
(562) 658-3510
Entity
Organization
Contact information
Practice address
401 BICENTENNIAL WAY, 2ND FLOOR, SANTA ROSA, CA 95403
(707) 571-4357
(707) 571-4894
Mailing address
401 BICENTENNIAL WAY, 2ND FLOOR, SANTA ROSA, CA 95403-2149
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY34285
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0566692
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA342850
—
CA
Enumeration date
01/30/2007
Last updated
06/01/2018
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