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Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER ONCOLOGY PHARMACY #520
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA LEE POLCHAK (VP PHARMACY OPERATIONS & SVCS, SCAL)
(562) 658-3510
Entity
Organization
Contact information
Practice address
10800 MAGNOLIA AVE, MOB 2, RIVERSIDE, CA 92505-3043
(951) 353-3623
Mailing address
12254 BELLFLOWER BLVD FL 2, PHARMACY OPERATIONS, DOWNEY, CA 90242-2804
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PHY48273
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5624778
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/29/2006
Last updated
06/22/2023
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