Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
KAISER HEALTH PLAN ARDEN REFILL PHY 612
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID KVANCZ (VP PHRMCY STRATEGY OPERATIONS)
(562) 658-3510
Entity
Organization
Contact information
Practice address
3184 ARDEN WAY, SACRAMENTO, CA 95825-3701
(916) 486-5269
(916) 486-5273
Mailing address
12254 BELLFLOWER BLVD FL 2, PHARMACY PROFESSIONAL AFFAIRS, DOWNEY, CA 90242-2804
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY39981
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0565501
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA399810
—
CA
Enumeration date
01/05/2007
Last updated
12/21/2011
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