Organization
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Active
Other names
KAISER PERMANENTE TUALATIN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ALFRED LYMAN PHARMD, BCPS (EXECUTIVE DIRECTOR, REGIONAL PHARMA)
(800) 813-2000
Entity
Organization
Contact information
Practice address
19185 SW 90TH AVE, TUALATIN, OR 97062-7558
(866) 280-8818
(503) 885-7333
Mailing address
19185 SW 90TH AVE, TUALATIN, OR 97062-7558
(866) 280-8818
(503) 885-7333
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
RP-00001829-CS
OR
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2079066
PK
—
05
—
230431
—
OR
Enumeration date
06/04/2006
Last updated
06/01/2021
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