Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC
Active
Other names
Kaiser Permanente Townpark Clinic 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) 514-5636
(770) 794-4009
Mailing address
750 TOWNPARK LN NW, KENNESAW, GA 30144-5579
(770) 514-5636
(770) 794-4009
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
PHCL000017
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1162306
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/20/2012
Last updated
08/04/2021
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