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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
1333600000XPharmacyPHY55589CA
23336C0004XCompounding PharmacyPHY55589CA

General Provider Information

NPI Number : 1780032623
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 : 6041 CADILLAC AVE
Second Line : RM 4644
City : LOS ANGELES
State : CA
Zip : 90034-1702
Country : US
Telephone Number : 323-857-4123
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 : 06/01/2016
Last Update Date : 07/05/2023

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Directions to “KAISER FOUNDATION HEALTH PLAN INC ” Practice Location

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