Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC
Active
Other names
Kaiser Permanente Townpark Infusion Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(770) 712-5654
Entity
Organization
Contact information
Practice address
750 TOWNPARK LN NW, KENNESAW, GA 30144-5579
(770) 514-5487
(770) 514-5433
Mailing address
750 TOWNPARK LN NW, KENNESAW, GA 30144-5579
(770) 514-5487
(770) 514-5433
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHCL000018
GA
3336C0004X
Compounding Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134075
PK
—
Enumeration date
03/09/2012
Last updated
08/04/2021
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