1922103142 NPI number — WILSHIRE PHARMCARE, INC.

Table of content: (NPI 1922103142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922103142 NPI number — WILSHIRE PHARMCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILSHIRE PHARMCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED PHARMACY SOLUTIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922103142
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26611 CABOT RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653-7031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-348-7900
Provider Business Mailing Address Fax Number:
949-348-7922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26611 CABOT RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-7031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-348-7900
Provider Business Practice Location Address Fax Number:
949-348-7922
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
KYONG YOL
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
323-295-5585

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHY55921 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1922103142 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27874737 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 474253 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1692434 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922103142 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0547185 . This is a "NCPDP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2104940 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922103142 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ56233Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1922103142 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922103142 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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