| Organization Name: | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. |
| NPI Number: | 1164597019 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEANNE G PETERSEN (CHIEF FINANCIAL OFFICER) |
| Mailing Address: | 5999 Burke Commons Rd 4th Floor Burke |
| State: | VA US |
| Postal Code: | 220152880 |
| Phone Number: | 7032497750 |
| Fax Number: | |
| NPI Enumeration Date: | 11/22/2006 |
| NPI Last Update Date: | 12/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336M0003X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Managed Care Organization Pharmacy |
| Taxonomy Definition: | A pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO |