Provider Demographics
NPI:1215406913
Name:KAISER FOUNDATION HEALTHPLAN OF COLORADO
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTHPLAN OF COLORADO
Other - Org Name:KAISER PERMANENTE ACERO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENESE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:303-326-6717
Mailing Address - Street 1:16601 E CENTRETECH PKWY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9045
Mailing Address - Country:US
Mailing Address - Phone:303-358-1902
Mailing Address - Fax:303-739-3660
Practice Address - Street 1:2625 W. PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004
Practice Address - Country:US
Practice Address - Phone:303-326-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HEALTH PLAN OF COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-26
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy