Healthcare Provider Details

I. General information

NPI: 1194516419
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 PINE ST
EVERETT WA
98201-3835
US

IV. Provider business mailing address

2921 NACHES AVE SW RCA-B1N-04
RENTON WA
98057-2617
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-1566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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