NPIMap

Organization Active NPI

Kaiser Foundation Health Plan Inc

  • Community/Retail Pharmacy
  • Colton, CA
National Provider Identifier
1164570818
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY30875 Issued in CA
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Practice address
789 South Cooley Drive
Colton, CA 92324
Phone
(866) 342-2805
NPI assigned
Jan 8, 2007
Organization subpart
No

Authorized official

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

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

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY30875 CA Primary

Addresses

NPPES NPI Registry

Primary practice location

789 South Cooley Drive
Colton, CA 92324

Mailing address

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

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
0565830OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1164570818MedicaidCA

Other names 1

NPPES NPI Registry
  • KAISER PERMANENTE PHARMACY #163 Other name

Electronic endpoints 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 13, 2023.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686614400000",
    "number": "1164570818",
    "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": "789 SOUTH COOLEY DRIVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "92324",
            "telephone_number": "866-342-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "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": "PHY30875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0565830",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164570818",
            "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": "789 SOUTH COOLEY DRIVE",
            "city": "COLTON",
            "state": "CA",
            "country_code": "US",
            "postal_code": "92324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "KAISER PERMANENTE PHARMACY #163",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "KAISER PERMANENTE PHARMACY #163",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Colton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.