Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN MOB PHY 751
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
7520 ARROYO CIR, GILROY, CA 95020-7303
(408) 848-4641
(408) 848-4791
Mailing address
12254 BELLFLOWER BLVD FL 2, PHARMACY PROFESSIONAL AFFAIRS, DOWNEY, CA 90242-2804
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY32812
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0527866
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA328120
—
CA
Enumeration date
01/05/2007
Last updated
04/11/2012
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