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NPI Code Detail

MEDICARE: KAISER FOUNDATION HEALTH PLAN INC

MEDICARE: KAISER FOUNDATION HEALTH PLAN INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPHY37029CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10564698OTHERNCPDP PROVIDER IDENTIFICATION NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659428977
Entity Type Code : Organization
Provider Name (Legal Business Name) : KAISER FOUNDATION HEALTH PLAN INC
Provider Business Mailing Address
First Line : 12254 BELLFLOWER BLVD FL 2
Second Line : PHARMACY OPERATIONS
City : DOWNEY
State : CA
Zip : 90242-2804
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3900 E PACIFIC COAST HWY
Second Line :
City : LONG BEACH
State : CA
Zip : 90804-2013
Country : US
Telephone Number : 866-352-8633
Fax Number :
Authorized Official
Title or Position : VP PHARMACY OPERATIONS SVCS, SCAL
Name : RHONDA LEE POLCHAK
Credential :
Telephone Number : 562-658-3510
Provider Enumeration Date : 01/05/2007
Last Update Date : 06/23/2023

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