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General NPI Number Information
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NPI Number | 1306820410
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Entity Type | Organization
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Legal Business Name | WILSHIRE LA JOLLA PHARMACY INC
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 6360 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90048-5603
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Country | US
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Telephone | 323-658-6611
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Fax | 323-658-7021
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Provider Business Mailing Address
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Address Line | 6360 WILSHIRE BLVD LOBBY
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City | LOS ANGELES
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State | CA
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Zip | 90048-5603
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Country | US
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Telephone | 323-658-6611
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Fax | 323-658-7021
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Authorized Official
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Title or Position | PRESIDENT, OWNER
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Name | CHERYL CHE
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Credential |
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Telephone | 323-658-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY44186
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License Number State | CA
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