Healthcare Provider Details

I. General information

NPI: 1700632189
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 NACHES AVE SW
RENTON WA
98057-2617
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 866-523-6059
  • Fax: 877-626-7035
Mailing address:
  • Phone: 206-630-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE M BARLOW
Title or Position: MANAGER
Credential:
Phone: 509-241-7343