Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER PERMANENTE PHARMACY #102
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
3701 BROADWAY FL 1, OAKLAND, CA 94611-5613
(510) 752-4188
Mailing address
1800 HARRISON ST FL 13, OAKLAND, CA 94612-3466
(510) 752-4188
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY 49853
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770723645
—
CA
01
—
5633979
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
03/04/2009
Last updated
10/20/2020
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