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General NPI Number Information
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NPI Number | 1063969160
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Entity Type | Organization
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Legal Business Name | KAISER PERMANENTE
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 2875 NW STUCKI AVE
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City | HILLSBORO
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State | OR
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Zip | 97124-5806
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Country | US
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Telephone | 971-310-2149
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 NW STUCKI AVE
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City | HILLSBORO
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State | OR
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Zip | 97124-5806
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Country | US
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Telephone | 971-310-2149
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Fax |
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Authorized Official
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Title or Position | STAFF PHARMACIST
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Name | MRS. PRUDENCIA SABADO BABAL
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Credential | PHARM D.
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Telephone | 971-310-2149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7866
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License Number State | OR
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