Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN FABIOLA 3 PHY 116
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
3801 HOWE ST FL 3, OAKLAND, CA 94611-5312
(510) 752-7643
(510) 752-7638
Mailing address
12254 BELLFLOWER BLVD FL 2, PHARMACY PROFESSIONAL AFFAIRS, DOWNEY, CA 90242-2804
(562) 658-3671
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY39671
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0529113
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA396710
—
CA
Enumeration date
01/08/2007
Last updated
12/21/2011
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