Organization
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Active
Other names
Kaiser Permanente Interstate South 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
3500 N INTERSTATE AVE, PORTLAND, OR 97227-1196
(503) 331-6186
(503) 331-6187
Mailing address
5725 NE 138TH AVE, PORTLAND, OR 97230-3409
(503) 261-7980
(503) 261-7567
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHNR.FO.60572833
WA
3336C0002X
Clinic Pharmacy
Primary
RP-0001643-CS
OR
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2078923
PK
—
05
—
500622283
—
OR
05
—
6029821
—
WA
Enumeration date
07/18/2006
Last updated
06/01/2021
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