Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER PERMANENTE PHARMACY #163
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
789 SOUTH COOLEY DRIVE, COLTON, CA 92324
(866) 342-2805
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
PHY30875
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0565830
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
1164570818
—
CA
Enumeration date
01/08/2007
Last updated
06/13/2023
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