Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN PHARMACY 201
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
3900 LAKEVILLE HWY, PETALUMA, CA 94954-5698
(707) 765-3452
(707) 765-3454
Mailing address
1800 HARRISON ST FL 13, OAKLAND, CA 94612-3466
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY35387
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0564838
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA353870
—
CA
Enumeration date
01/05/2007
Last updated
11/24/2020
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