Organization
KAISER FOUNDATION HOSPITALS
Active
Other names
KAISER PERMANENTE PHARMACY #142
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID KVANCZ (VP NAT'L PHRMCY PROG & SVCS)
(562) 658-3510
Entity
Organization
Contact information
Practice address
27400 HESPERIAN BLVD, HAYWARD, CA 94545-4235
(510) 784-6716
(510) 784-6717
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
PHY46815
CA
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5616125
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA468150
—
CA
Enumeration date
01/08/2007
Last updated
04/22/2021
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