Organization
KAISER FOUNDATION HOSPITALS
Active
Other names
KAISER FOUND HOSP PHARMACY #49A
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN RENOUARD BROWN (VP PHARMACY OPERATIONS AND SERVICES)
(510) 625-2363
Entity
Organization
Contact information
Practice address
1777 W YOSEMITE AVE, MANTECA, CA 95337-5130
(209) 825-3616
(209) 825-3617
Mailing address
1800 HARRISON ST FL 13, OAKLAND, CA 94612-3466
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336I0012X
Institutional Pharmacy
Primary
HSP46930
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5616113
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHB469300
—
CA
Enumeration date
01/08/2007
Last updated
04/28/2021
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