KAISER PERMANENTE PHARMACY #397
NPI 1093192577
Pharmacy - Compounding Pharmacy in San Rafael, CA

Q: What is Kaiser Foundation Health Plan Inc's NPI number?

The NPI number for Kaiser Foundation Health Plan Inc is 1093192577. It was assigned to this organization in the NPPES registry on May 4, 2015. The provider is also known as Kaiser Permanente Pharmacy #397.

Q: What is Kaiser Foundation Health Plan Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Compounding Pharmacy, with taxonomy code 3336C0004X.

Active since May 04, 2015CLIA 05D0688085 · Waiver

99 MONTECILLO RD, BLDG 2 FL-5 RM 5254, SAN RAFAEL, CA 94903(415) 444-2319 Get Directions Write a Review

NPPES record last updated: June 1, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Kaiser Permanente Pharmacy #397 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KAISER PERMANENTE PHARMACY #397 (NPI 1093192577) is a healthcare organization registered as a compounding pharmacy in San Rafael, California and active in the NPI registry since May 2015. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists William Perry Flowers, Vp Acute Transitional Care, as its authorized official.

NPPES Registry Identity

NPI1093192577

Entity TypeOrganization

Primary Taxonomy3336C0004X

Legal Business NameKAISER FOUNDATION HEALTH PLAN INC

Location Address99 MONTECILLO RD, BLDG 2 FL-5 RM 5254San Rafael, CA 94903

Mailing Address99 Montecillo Rd, Bldg 2 Fl-5 Rm 5254San Rafael, CA 94903-3308

Phone(415) 444-2319

Organization SubpartYes

Authorized OfficialWilliam Perry FlowersVp Acute Transitional Care · (562) 658-3510

Enumeration DateMay 4, 2015

Last NPPES UpdateJune 1, 2018

✔ NPI 1093192577 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Compounding PharmacySuppliers

Taxonomy Code3336C0004X

License✔ Licensed in CA · PHY52494

Definition

A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice.

Also ListedPharmacyTaxonomy 333600000X · License PHY52494 (CA)

99 MONTECILLO RD, San Rafael, CA 94903

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Other Names 1

Other NameKaiser Permanente Pharmacy #397

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0688085

Kaiser Foundation Hspital- San Rafael · San Rafael, CA

Active · expires Aug 31, 2026

CLIA Number05D0688085

Laboratory TypePhysician Office

Certificate Effective DateSeptember 1, 2024

Certificate Expiration DateAugust 31, 2026

Laboratory DirectorJenny Dong

Laboratory Phone(510) 672-1357

Laboratory LocationKaiser Foundation Hspital- San Rafael99 Montecillo Road, San Rafael, CA 94903

CLIA data matches this NPI record on: Address

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. MARTA JUDY FRIEDMAN LCSW, JD

Social Worker (Clinical)