Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN C PHY 712
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID KVANCZ (VP NATL PHRMCY PROG & SVCS)
(562) 658-3510
Entity
Organization
Contact information
Practice address
10725 INTERNATIONAL DR FL 2, RANCHO CORDOVA, CA 95670-7967
(916) 631-2309
(916) 631-2316
Mailing address
12254 BELLFLOWER BLVD FL 2, ATTN: TERESA RIVERA, DOWNEY, CA 90242-2804
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY37229
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0565246
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHB372290
—
CA
Enumeration date
01/08/2007
Last updated
12/22/2010
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