Provider Demographics
NPI:1609118785
Name:KAISER
Entity Type:Organization
Organization Name:KAISER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CANLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-813-7957
Mailing Address - Street 1:281 HAAS AVE
Mailing Address - Street 2:#201
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3705
Mailing Address - Country:US
Mailing Address - Phone:510-940-5138
Mailing Address - Fax:
Practice Address - Street 1:281 HAAS AVE
Practice Address - Street 2:#201
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-3705
Practice Address - Country:US
Practice Address - Phone:510-940-5138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH49565183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Multi-Specialty