A pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's covered members only.
GA license #PHRE007915taxonomy 3336M0003X
Identifiers
Type
Value
Notes
01
1136971
NCPDP PROVIDER IDENTIFICATION NUMBER
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
KAISER PERMANENTE GLENLAKE
Type code 3recorded 2021-08-04
KAISER PERMANENTE GLENLAKE
Type code 3recorded 2007-07-19
Practice context
Multi-provider organization.
7 individual providers on file at this primary address.
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