Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Parent organization
KAISER FOUNDATION HEALTH PLAN INC
Other names
KAISER PERMANENTE PHARMACY NO 157
Organization subpart
Yes
Provider details
NPI number
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Authorized official
RHONDA LEE POLCHAK (VP PHARMACY OPERATIONS & SVCS, SCAL)
(562) 658-3510
Entity
Organization
Contact information
Practice address
14011 PARK AVE, VICTORVILLE, CA 92392-2413
(866) 352-1151
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
PHY43724
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0501812
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
1548317860
—
CA
Enumeration date
01/05/2007
Last updated
06/13/2023
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