NPIMap

Organization Active NPI

Kaiser Foundation Health Plan Inc

  • Community/Retail Pharmacy
  • Roseville, CA
National Provider Identifier
1053469866
Registry record updated Apr 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY40894 Issued in CA
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Practice address
1600 Eureka Rd FL 2
Roseville, CA 95661-3027
Phone
(916) 784-5537
Fax
(916) 784-5539
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Kvancz
Title
VP Nat'L Phrmcy Prog & Svcds
Phone
(562) 658-3510

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHY40894 CA Primary

Addresses

Primary practice location

1600 Eureka Rd FL 2
Roseville, CA 95661-3027

Mailing address

12254 Bellflower Blvd FL 2
Pharmacy Professional Affairs
Downey, CA 90242-2804
Phone (562) 658-3671

Other identifiers 2

IdentifierTypeStateIssuer
0565400OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PHA408940MedicaidCA

Other names 1

  • KAISER HEALTH EUREKA 2ND FL PHARMACY 596 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kaiser FDN HLTH Plan Phcy379 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1600 Eureka Rd
Fl 2
Roseville, CA 95661
Phone (916) 784-5268

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335139200000",
    "number": "1053469866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12254 BELLFLOWER BLVD FL 2",
            "address_2": "PHARMACY PROFESSIONAL AFFAIRS",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902422804",
            "telephone_number": "562-658-3671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 EUREKA RD FL 2",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613027",
            "telephone_number": "916-784-5537",
            "fax_number": "916-784-5539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2012-04-23",
        "status": "A",
        "authorized_official_last_name": "KVANCZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP NAT'L PHRMCY PROG & SVCDS",
        "authorized_official_telephone_number": "562-658-3510"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY40894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0565400",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA408940",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KAISER HEALTH EUREKA 2ND FL PHARMACY 596",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.