Healthcare Provider Details

I. General information

NPI: 1992742894
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E MILL PLAIN BLVD
VANCOUVER WA
98661-4329
US

IV. Provider business mailing address

5725 NE 138TH AVE
PORTLAND OR
97230-3409
US

V. Phone/Fax

Practice location:
  • Phone: 360-699-6068
  • Fax:
Mailing address:
  • Phone: 503-261-7980
  • Fax: 503-261-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number00001845
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVE LOGAN
Title or Position: DIRECTOR, PHARMACY OPERATIONS
Credential: R.PH.
Phone: 503-261-7566