Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER PHARMACY 1 WEST PHARMACY 581
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
401 BICENTENNIAL WAY FL 1, SANTA ROSA, CA 95403-2149
(707) 393-4180
(707) 393-4532
Mailing address
1800 HARRISON ST FL 13, OAKLAND, CA 94612-3466
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY22113
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0572049
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA221130
—
CA
Enumeration date
01/05/2007
Last updated
02/28/2023
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