Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH EUREKA 2ND FL PHARMACY 596
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID KVANCZ (VP NAT'L PHRMCY PROG & SVCDS)
(562) 658-3510
Entity
Organization
Contact information
Practice address
1600 EUREKA RD FL 2, ROSEVILLE, CA 95661-3027
(916) 784-5537
(916) 784-5539
Mailing address
12254 BELLFLOWER BLVD FL 2, PHARMACY PROFESSIONAL AFFAIRS, DOWNEY, CA 90242-2804
(562) 658-3671
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY40894
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0565400
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA408940
—
CA
Enumeration date
01/08/2007
Last updated
04/23/2012
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