Organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC.
Active
Other names
KAISER PERMANENTE REFILL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE SANDERS (PHCY COMPLIANCE MGR)
(770) 712-5654
Entity
Organization
Contact information
Practice address
4000 DEKALB TEC PKWY, STE 320, ATLANTA, GA 30340-2761
(770) 220-3787
(770) 220-3796
Mailing address
4000 DEKALB TEC PKWY, STE 320, ATLANTA, GA 30340-2761
(770) 220-3787
(770) 220-3796
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE008623
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014604
PK
—
Enumeration date
08/20/2006
Last updated
08/04/2021
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