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NPI Code Detail

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336M0003XManaged Care Organization Pharmacy
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy
43336C0002XClinic PharmacyCF00003623WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12108627OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184670739
Entity Type Code : Organization
Provider Name (Legal Business Name) : KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Provider Business Mailing Address
First Line : 5725 NE 138TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-3409
Country : US
Telephone Number : 503-261-7980
Fax Number : 503-261-7565
Provider Business Practice Location Address
First Line : 12607 SE MILL PLAIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98684-6055
Country : US
Telephone Number : 360-896-4466
Fax Number : 360-896-4467
Authorized Official
Title or Position : EXECUTIVE DIRECTOR, REGIONAL PHARMA
Name : ALFRED LYMAN
Credential : PHARMD, BCPS
Telephone Number : 800-813-2000
Provider Enumeration Date : 05/25/2006
Last Update Date : 06/01/2021

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Directions to “KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST ” Practice Location

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