Organization
KAISER PERMANENTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. IRENE PHAN PHARM.D. (PHARMACY MANAGER)
(650) 301-5781
Entity
Organization
Contact information
Practice address
395 HICKEY BLVD, 1ST FLOOR PHARMACY, DALY CITY, CA 94015-2770
(650) 301-5700
(650) 301-5780
Mailing address
395 HICKEY BLVD, 1ST FLOOR PHARMACY, DALY CITY, CA 94015-2770
(650) 301-5700
(650) 301-5780
Taxonomy
Speciality
Code
Description
License number
State
3336M0003X
Managed Care Organization Pharmacy
Primary
PHA46565
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHA465650
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
05/30/2007
Last updated
08/22/2020
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