NPIMap

Organization Active NPI

Kaiser Foundation Health Plan Inc

  • Community/Retail Pharmacy
  • North Hollywood, CA
National Provider Identifier
1124460191
Registry record updated Jun 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY 51530 Issued in CA
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Practice address
5250 Lankershim Blvd FL 9
North Hollywood, CA 91601-3186
Phone
(855) 777-8073
NPI assigned
Jul 19, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2023

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

Authorized official

Name
Rhonda Lee Polchak
Title
VP Pharmacy Operations & SVCS, Scal
Phone
(562) 658-3510

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY 51530 CA Primary

Addresses

Primary practice location

5250 Lankershim Blvd FL 9
North Hollywood, CA 91601-3186

Mailing address

12254 Bellflower Blvd FL 2
Pharmacy Operations
Downey, CA 90242-2804

Other identifiers 3

IdentifierTypeStateIssuer
2141494OtherPK
1124460191MedicaidCA
5648463OtherCANCPDP

Other names 1

  • Kaiser Permanente Pharmacy #264 Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE)

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

5250 Lankershim Blvd
Fl 9
North Hollywood, CA 91601
Phone (818) 508-2681

NPI Registry JSON

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

{
    "created_epoch": "1374192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685664000000",
    "number": "1124460191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12254 BELLFLOWER BLVD FL 2",
            "address_2": "PHARMACY OPERATIONS",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902422804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5250 LANKERSHIM BLVD FL 9",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916013186",
            "telephone_number": "855-777-8073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-19",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A",
        "authorized_official_last_name": "POLCHAK",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "VP PHARMACY OPERATIONS & SVCS, SCAL",
        "authorized_official_telephone_number": "562-658-3510"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY 51530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2141494",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124460191",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5648463",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5250 Lankershim Blvd Fl 9",
            "city": "North Hollywood",
            "state": "CA",
            "country_code": "US",
            "postal_code": "916013186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaiser Permanente Pharmacy #264",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in North Hollywood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; 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.