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NPI Code Detail

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336M0003XManaged Care Organization Pharmacy
23336C0002XClinic PharmacyRP-0000972-CSOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
32078382OTHERPK

General Provider Information

NPI Number : 1306883301
Entity Type Code : Organization
Provider Name (Legal Business Name) : KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Provider Business Mailing Address
First Line : 19500 SE STARK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97233-5757
Country : US
Telephone Number : 866-280-2123
Fax Number : 503-669-3991
Provider Business Practice Location Address
First Line : 19500 SE STARK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97233-5757
Country : US
Telephone Number : 866-280-2123
Fax Number : 503-669-3991
Authorized Official
Title or Position : EXECUTIVE DIRECTOR, REGIONAL PHARMA
Name : ALFRED LYMAN
Credential : PHARMD, BCPS
Telephone Number : 800-813-2000
Provider Enumeration Date : 05/31/2006
Last Update Date : 06/01/2021

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Directions to “KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST ” Practice Location

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