NPIMap

Organization Active NPI

Kaiser Foundation Health Plan Inc

  • Compounding Pharmacy
  • Walnut Creek, CA
National Provider Identifier
1043376312
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
License
PHY46988 Issued in CA
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Practice address
1425 S Main St
2ND FL
Walnut Creek, CA 94596-5318
Phone
(925) 295-5438
Fax
(925) 295-6779
NPI assigned
Dec 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kathryn Renouard Brown
Title
VP Pharmacy Operations and Services
Phone
(510) 625-2363

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Compounding Pharmacy 3336C0004X PHY46988 CA Primary

Addresses

Primary practice location

1425 S Main St
2ND FL
Walnut Creek, CA 94596-5318

Mailing address

1800 Harrison St FL 13
Oakland, CA 94612-3466

Other identifiers 1

IdentifierTypeStateIssuer
5624920OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • KAISER PERMANENTE PHARMACY #514 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kaiser FDN HLTH Plan Phcy379 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1425 S Main St
Fl 2
Walnut Creek, CA 94596
Phone (925) 295-5965

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1043376312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HARRISON ST FL 13",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946123466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 S MAIN ST",
            "address_2": "2ND FL",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965318",
            "telephone_number": "925-295-5438",
            "fax_number": "925-295-6779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "RENOUARD",
        "authorized_official_title_or_position": "VP PHARMACY OPERATIONS AND SERVICES",
        "authorized_official_telephone_number": "510-625-2363"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "CA",
            "license": "PHY46988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5624920",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KAISER PERMANENTE PHARMACY #514",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KAISER PERMANENTE PHARMACY #514",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walnut Creek, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.