Organization
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Active
Other names
Kaiser Permanente Skyline Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ALFRED LYMAN PHARMD, BCPS (EXECUTIVE DIRECTOR, REGIONAL PHARMA)
(800) 813-2000
Entity
Organization
Contact information
Practice address
5125 SKYLINE RD S, SALEM, OR 97306-9427
(866) 280-4583
(503) 588-6579
Mailing address
5125 SKYLINE RD S, SALEM, OR 97306-9427
(866) 280-4583
(503) 588-6579
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
RP0001106
OR
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136734
—
OR
01
—
2078435
PK
—
05
—
6019350
—
WA
Enumeration date
06/05/2006
Last updated
06/01/2021
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