| Organization Name: | KAISER FOUNDATION HEALTH PLAN INC |
| NPI Number: | 1053477323 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID KVANCZ (VP NAT'L PHRMCY PROG & SVCS) |
| Mailing Address: | 2295 S Vineyard Ave Basement Ontario |
| State: | CA US |
| Postal Code: | 917617925 |
| Phone Number: | 9097242140 |
| Fax Number: | |
| NPI Enumeration Date: | 12/29/2006 |
| NPI Last Update Date: | 11/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | PHY47112 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |