| NPI | 1255488573 |
|---|---|
| Doing Business As | KAISER HEALTH PLAN DIVISADERO PHY 314 |
| Entity Type | Organization |
| Authorized Contact | DAVID KVANCZ VP Nat'l Phrmcy Prog & Svcs 562-658-3510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CA PHY35832) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2011-12-21 |