Organization
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Active
Other names
Kaiser Permanente Keizer Station Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ALFRED E. LYMAN JR. PHARMD., BCPS (EXEC DIRECTOR REGIONAL PHARMACY)
(503) 261-7980
Entity
Organization
Contact information
Practice address
5940 ULALI DR NE, KEIZER, OR 97303-1500
(844) 854-9364
(503) 304-5721
Mailing address
5725 NE 138TH AVE, PORTLAND, OR 97230-3409
(844) 854-9346
(503) 304-5721
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
RP-0002984
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148106
PK
—
01
—
3845318
NCPDP
—
05
—
500678090
—
OR
Enumeration date
09/30/2014
Last updated
06/01/2021
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