Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN MODESTO PHY
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN RILEY (OP PHARMACY MGR)
(209) 557-1146
Entity
Organization
Contact information
Practice address
1625 I ST, MODESTO, CA 95354-1121
(209) 557-1115
(209) 557-1125
Mailing address
1625 I ST, MODESTO, CA 95354-1121
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
PHY41599
CA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0543682
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
PHA415990
—
CA
Enumeration date
01/05/2007
Last updated
09/11/2025
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