Organization
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Active
Parent organization
KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC
Other names
Kaiser Permanente Fredericksburg Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC
Authorized official
COLLEEN E SWINTON (CREDENTIALING DIRECTOR)
(301) 257-2797
Entity
Organization
Contact information
Practice address
1201 HOSPITAL DR, FREDERICKSBURG, VA 22401-8428
(540) 368-3800
Mailing address
4000 GARDEN CITY DR, HYATTSVILLE, MD 20785-2418
(301) 257-2797
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
0201004261
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4841222
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/24/2008
Last updated
07/25/2025
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