Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER PERMANENTE PHARMACY #217
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
4405 VANDEVER AVE FL 1, SAN DIEGO, CA 92120-3315
(866) 451-4942
Mailing address
12254 BELLFLOWER BLVD FL 2, PHARMACY OPERATIONS, DOWNEY, CA 90242-2804
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY46253
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0588511
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
1093863821
—
CA
Enumeration date
01/08/2007
Last updated
06/14/2023
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