Organization
KAISER FOUNDATION HEALTH PLAN INC
Active
Other names
Kaiser Permanente PHY #193
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA LEE POLCHAK (VP PHARMACY OPERATIONS & SVCS, SCAL)
(562) 658-3510
Entity
Organization
Contact information
Practice address
17296 SLOVER AVE, PALM COURT 1, FONTANA, CA 92337-7585
(909) 609-3360
Mailing address
12254 BELLFLOWER BLVD FL 2, PHARMACY OPERATIONS DEPARTMENT, DOWNEY, CA 90242-2804
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
PHY48828
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5628827
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/12/2007
Last updated
06/12/2023
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