NPIMap

Organization Active NPI

Kaiser Foundation Health Plan Inc

Doing business as Kaiser Permanente Phrmcy #120

  • Community/Retail Pharmacy
  • Pinole, CA
National Provider Identifier
1124263959
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY49249 Issued in CA
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Doing business as
Kaiser Permanente Phrmcy #120
Practice address
1301 Pinole Valley Rd FL 1
Pinole, CA 94564-1384
Phone
(510) 243-4320
NPI assigned
Dec 8, 2008
Last updated
Oct 20, 2020By the provider in NPPES
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X PHY49249 CA Primary

Addresses

Primary practice location

1301 Pinole Valley Rd FL 1
Pinole, CA 94564-1384

Mailing address

1800 Harrison St FL 13
Oakland, CA 94612-3466
Phone (510) 243-4320

Other identifiers 2

IdentifierTypeStateIssuer
1124263959MedicaidCA
5633082OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • KAISER PERMANENTE PHRMCY #120 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Foundation HLTH379 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

1301 Pinole Valley Rd
Fl 1
Pinole, CA 94564
Phone (510) 243-4320

NPI Registry JSON

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

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1124263959",
    "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",
            "telephone_number": "510-243-4320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PINOLE VALLEY RD FL 1",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945641384",
            "telephone_number": "510-243-4320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-08",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY49249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124263959",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5633082",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KAISER PERMANENTE PHRMCY #120",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KAISER PERMANENTE PHRMCY #120",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pinole, 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.