Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER PERMANENTE PHARMACY #103
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID KVANCZ (NAT'L VP PHRMCY PROG & SVCS)
(562) 658-3510
Entity
Organization
Contact information
Practice address
3701 BROADWAY FL 4, OAKLAND, CA 94611-5613
(562) 658-3671
Mailing address
12254 BELLFLOWER BLVD, PHARM PROFESSIONAL AFFAIRS FLOOR 2, OAKLAND, CA 94611
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY49884
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104060383
—
CA
01
—
5634224
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/01/2009
Last updated
01/25/2011
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