Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN MAIN PHY 551
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
3400 DELTA FAIR BLVD, ANTIOCH, CA 94509-4004
(925) 779-5173
(925) 779-5465
Mailing address
3400 DELTA FAIR BLVD, ANTIOCH, CA 94509-4004
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY32380
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0528325
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA323800
—
CA
Enumeration date
01/08/2007
Last updated
04/11/2012
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