Provider Demographics
NPI:1740340983
Name:KAISER PERMANENTE ASHBURN MED CTR
Entity type:Organization
Organization Name:KAISER PERMANENTE ASHBURN MED CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:703-227-5006
Mailing Address - Street 1:43480 YUKON DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43480 YUKON DR
Practice Address - Street 2:STE 100
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6984
Practice Address - Country:US
Practice Address - Phone:703-227-5006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010041213336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4839669OtherOTHER ID NUMBER-COMMERCIAL NUMBER
H2150Medicare ID - Type Unspecified