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Organization

KAISER FOUNDATION HEALTH PLAN INC

Active
Other names
KAISER ONCOLOGY PHARMACY #104
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 3, OAKLAND, CA 94611-5613
(510) 752-6564
Mailing address
1800 HARRISON ST FL 13, OAKLAND, CA 94612-3466
(510) 752-6564

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
3336C0004X
Compounding Pharmacy
Primary
PHY49905
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5634250
NCPDP PROVIDER IDENTIFICATION NUMBER
Enumeration date
05/06/2009
Last updated
10/20/2020
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