NPIMap

Organization Active NPI

Kaiser Foundation Health Plan of the Northwest

Doing business as Kaiser Permanente Keizer Station Pharmacy

  • Clinic Pharmacy
  • Keizer, OR
National Provider Identifier
1689077000
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
RP-0002984 Issued in OR
Legal business name
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Doing business as
Kaiser Permanente Keizer Station Pharmacy
Practice address
5940 Ulali Dr NE
Keizer, OR 97303-1500
Phone
(844) 854-9364
Fax
(503) 304-5721
NPI assigned
Sep 30, 2014
Last updated
Jun 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Alfred E. Lyman Jr., PHARMD., BCPS
Title
Exec Director Regional Pharmacy
Phone
(503) 261-7980

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Clinic Pharmacy 3336C0002X RP-0002984 OR Primary

Addresses

Primary practice location

5940 Ulali Dr NE
Keizer, OR 97303-1500

Mailing address

5725 NE 138TH Ave
Portland, OR 97230-3409
Phone (844) 854-9346

Other identifiers 3

IdentifierTypeStateIssuer
2148106OtherPK
3845318OtherNCPDP
500678090MedicaidOR

Other names 1

  • Kaiser Permanente Keizer Station Pharmacy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Permenente150 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

NPI Registry JSON

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

{
    "created_epoch": "1412035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1689077000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5725 NE 138TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972303409",
            "telephone_number": "844-854-9346",
            "fax_number": "503-304-5721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5940 ULALI DR NE",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973031500",
            "telephone_number": "844-854-9364",
            "fax_number": "503-304-5721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-30",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "LYMAN",
        "authorized_official_first_name": "ALFRED",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "EXEC DIRECTOR REGIONAL PHARMACY",
        "authorized_official_telephone_number": "503-261-7980",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PHARMD., BCPS"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "OR",
            "license": "RP-0002984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2148106",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3845318",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500678090",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5940 Ulali Dr NE",
            "city": "Keizer",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973031500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaiser Permanente Keizer Station Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kaiser Permanente Keizer Station Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Keizer, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; 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.