Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN MOB 3 PHY 213
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERT CARVER (VP PHRMCY STRATEGY OPERATIONS)
(562) 658-3510
Entity
Organization
Contact information
Practice address
975 SERENO DR FL 2, VALLEJO, CA 94589-2441
(707) 651-3443
(707) 651-3415
Mailing address
975 SERENO DR FL 2, VALLEJO, CA 94589-2441
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY37049
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0552768
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA370490
—
CA
Enumeration date
01/08/2007
Last updated
05/20/2010
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