=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922103142
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILSHIRE PHARMCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26611 CABOT RD STE B
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-7031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-348-7900
-----------------------------------------------------
Fax | 949-348-7922
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26611 CABOT RD STE B
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-7031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-348-7900
-----------------------------------------------------
Fax | 949-348-7922
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | SAMUEL KYONG YOL LEE
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 949-348-7900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------