MEDICARE: WILSHIRE LA JOLLA PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY44186	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0529377	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306820410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSHIRE LA JOLLA PHARMACY INC

Provider Business Mailing Address
First Line	:	6360 WILSHIRE BLVD
Second Line	:	LOBBY
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5603
Country	:	US
Telephone Number	:	323-658-6611
Fax Number	:	323-658-7021

Provider Business Practice Location Address
First Line	:	6360 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5603
Country	:	US
Telephone Number	:	323-658-6611
Fax Number	:	323-658-7021

Authorized Official
Title or Position	:	PRESIDENT, OWNER
Name	:	CHERYL CHE
Credential	:
Telephone Number	:	323-658-6611

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	03/18/2021

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Directions to “WILSHIRE LA JOLLA PHARMACY INC ” Practice Location

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