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General NPI Number Information
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NPI Number | 1154479947
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Entity Type | Organization
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Legal Business Name | KAISER FOUNDATION HEALTH PLAN INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 400 CRAVEN RD
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City | SAN MARCOS
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State | CA
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Zip | 92078-4201
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Country | US
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Telephone | 866-385-2650
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Fax |
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Provider Business Mailing Address
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Address Line | 12254 BELLFLOWER BLVD FL 2 PHARMACY OPERATIONS
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City | DOWNEY
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State | CA
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Zip | 90242-2804
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP PHARMACY OPERATIONS & SVCS SCAL
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Name | RHONDA LEE POLCHAK
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Credential |
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Telephone | 562-658-3510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY44860
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License Number State | CA
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