1588217236 NPI number — KAISER FOUNDATION HEALTH PLAN INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588217236 NPI number — KAISER FOUNDATION HEALTH PLAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAISER FOUNDATION HEALTH PLAN INC
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 PHARMACY #051
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:
1588217236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 HARRISON STREET FL 13
Provider Second Line Business Mailing Address:
NCAL PHARMACY OPERATIONS
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1021 RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-784-4540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
RENOUARD
Authorized Official Title or Position:
VP PHARMACY OPERATIONS & SVCS, NCAL
Authorized Official Telephone Number:
916-764-2236

Provider Taxonomy Codes

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

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

  • Identifier: 1588217236 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5670078 . This is a "NCPDP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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