1548807738 NPI number — KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Table of content: (NPI 1548807738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548807738 NPI number — KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KAISER PERMANENTE WEST OLYMPIA PHARMACY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548807738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 SW 27TH STREET
Provider Second Line Business Mailing Address:
RCG-D2W-06
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-9055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-630-1029
Provider Business Mailing Address Fax Number:
206-630-1025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 COOPER POINT ROAD SW
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-596-4810
Provider Business Practice Location Address Fax Number:
360-596-4848
Provider Enumeration Date:
12/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SCHARTMAN
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
206-630-2504

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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