Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER PERMANENTE PHARMACY
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
1717 E DATE PL, SAN BERNARDINO, CA 92404-4428
(866) 342-2823
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
PHY19771
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0543036
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
1134276454
—
CA
Enumeration date
01/05/2007
Last updated
07/05/2023
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