Organization
KAISER FOUNDATION HEALTH PLAN NORTHWEST
Active
Other names
Kaiser Sunnyside Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JIM DUNSCOMB R.PH. (SUPERVISOR)
(503) 571-2022
Entity
Organization
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 571-4222
(503) 571-4166
Mailing address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 571-4222
(503) 571-4166
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
00650
OR
3336M0003X
Managed Care Organization Pharmacy
00650
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136742
—
OR
01
—
3811848
NCPDP
OR
05
—
6019343
—
WA
Enumeration date
06/15/2006
Last updated
06/01/2021
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