Provider Demographics
NPI:1487944492
Name:KAISER FOUNDATION HEALTH PLAN INC
Entity type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHARMACY OPERATIONS AND SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:RENOUARD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-625-2363
Mailing Address - Street 1:1800 HARRISON ST FL 13
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3466
Mailing Address - Country:US
Mailing Address - Phone:650-299-2809
Mailing Address - Fax:
Practice Address - Street 1:1000 FRANKLIN PKWY
Practice Address - Street 2:FLOOR 1
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1922
Practice Address - Country:US
Practice Address - Phone:650-299-2809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY506263336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5640708OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA1487944492Medicaid