NPIMap

Kaiser Foundation Health Plan Inc

Organization Active NPI Compounding Pharmacy · Santa Clarita, CA

NPI 1740798248 · NPPES record last updated Jun 12, 2023

Key facts

NPI
1740798248
Entity type
Organization (NPI type 2)
Primary specialty
Compounding Pharmacy 3336C0004X
License
PHY56017 (CA)
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Practice address
26877 Tourney Rd
Mob 2 FL 2 RM #226
Santa Clarita, CA 91355-1846
Phone
(661) 290-7200
NPI assigned
Jan 18, 2018
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Kaiser FDN HLTH Plan Phcy (379 organizations share this tax ID)

Locations

26877 Tourney Rd
Fl 2
Santa Clarita, CA 91355
Phone (661) 290-7200

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PHY56017 CA
Compounding Pharmacy 3336C0004X PHY56017 CA Yes

Addresses

Primary practice location

26877 Tourney Rd
Mob 2 FL 2 RM #226
Santa Clarita, CA 91355-1846

Mailing address

12254 Bellflower Blvd FL 2
Downey, CA 90242-2804

Other identifiers

IdentifierTypeStateIssuer
5665445OtherCANCPDP

Other names

  • Kaiser Permanente Pharmacy #271C Other name

Electronic endpoints

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 JSON format, last updated by the provider on Jun 12, 2023.

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1740798248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12254 BELLFLOWER BLVD FL 2",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902422804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26877 TOURNEY RD",
            "address_2": "MOB 2 FL 2 RM #226",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913551846",
            "telephone_number": "661-290-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "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": "CA",
            "license": "PHY56017",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "CA",
            "license": "PHY56017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5665445",
            "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": "26877 Tourney Rd",
            "address_2": "MOB 2 FL 2 RM #226",
            "city": "Santa Clarita",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913551846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaiser Permanente Pharmacy #271C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Clarita, CA

All providers in Santa Clarita, CA · Compounding Pharmacy in California

Sources for this page

Verify at the official NPI Registry.