Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
Kaiser Permanente Forsyth Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SANDERS (PHARMACY COMPLIANCE MANAGER)
(770) 712-5654
Entity
Organization
Contact information
Practice address
1400 NORTHSIDE FORSYTH DR STE 350, CUMMING, GA 30041-6018
(404) 364-4824
(404) 949-5242
Mailing address
1400 NORTHSIDE FORSYTH DR STE 350, CUMMING, GA 30041-6018
(404) 364-4824
(404) 949-5242
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE009584
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1158840
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/16/2009
Last updated
08/04/2021
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