Healthcare Provider Details

I. General information

NPI: 1730213711
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11913 NE 195TH ST
BOTHELL WA
98011-3147
US

IV. Provider business mailing address

2921 NACHES AVE SW RCA-B1N-04
RENTON WA
98057
US

V. Phone/Fax

Practice location:
  • Phone: 425-489-3111
  • Fax: 425-489-3119
Mailing address:
  • Phone: 206-630-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberCF00002310
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCF00002310
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4916221
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerNCPDP

VIII. Authorized Official

Name: GAIL ANN ELLIOTT
Title or Position: PROGRAM MGR, RX REGULATORY
Credential:
Phone: 206-630-2222