Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
Kaiser Permanente Pharmacy #303
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
10305 PROMENADE PKWY FL 1, ELK GROVE, CA 95757-9400
(916) 478-5455
Mailing address
1800 HARRISON ST FL 13, OAKLAND, CA 94612-3466
(510) 625-2363
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY50656
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700164548
—
CA
01
—
5641534
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/27/2011
Last updated
09/02/2020
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