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Organization

KAISER FOUNDATION HEALTH PLAN INC

Active
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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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