Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
Kaiser Permanente Glenlake 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
20 GLENLAKE PKWY, ATLANTA, GA 30328-3473
(770) 677-6321
(770) 677-6320
Mailing address
20 GLENLAKE PKWY, ATLANTA, GA 30328-3473
(770) 677-6321
(770) 677-6320
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
PHCL000028
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2145689
PK
—
Enumeration date
04/09/2015
Last updated
08/04/2021
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