Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
Kaiser Permanente Pharmacy #596
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
1600 EUREKA RD BLDG 1, ROSEVILLE, CA 95661-3027
(916) 474-6554
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
PHY50836
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5643045
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/15/2012
Last updated
10/05/2020
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