Provider Demographics
NPI:1265034573
Name:KAISER FOUNDATION HEALTH PLAN OF COLORADO
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF COLORADO
Other - Org Name:KAISER PERMANENTE PREMIER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR PROVIDER ENROLLMENT COORD
Authorized Official - Prefix:
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-338-3382
Mailing Address - Street 1:3920 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4900
Mailing Address - Country:US
Mailing Address - Phone:719-755-6420
Mailing Address - Fax:719-755-6417
Practice Address - Street 1:3920 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4900
Practice Address - Country:US
Practice Address - Phone:719-755-6420
Practice Address - Fax:719-755-6417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HEALTH PLAN OF COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-11
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy