Provider Demographics
NPI:1528309366
Name:KAISER PERMANENTE MAS
Entity type:Organization
Organization Name:KAISER PERMANENTE MAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT AREA OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRUZITA
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:240-848-6675
Mailing Address - Street 1:11508 GLOXINIA CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9219
Mailing Address - Country:US
Mailing Address - Phone:240-848-6675
Mailing Address - Fax:301-618-5554
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:240-848-6675
Practice Address - Fax:301-618-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty