Healthcare Provider Details

I. General information

NPI: 1164570818
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 SOUTH COOLEY DRIVE
COLTON CA
92324
US

IV. Provider business mailing address

12254 BELLFLOWER BLVD FL 2 PHARMACY OPERATIONS
DOWNEY CA
90242-2804
US

V. Phone/Fax

Practice location:
  • Phone: 866-342-2805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY30875
License Number StateCA

VIII. Authorized Official

Name: RHONDA LEE POLCHAK
Title or Position: VP PHARMACY OPERATIONS & SVCS, SCAL
Credential:
Phone: 562-658-3510