Provider Demographics
NPI:1215031265
Name:WT HEALTHCARE INC
Entity Type:Organization
Organization Name:WT HEALTHCARE INC
Other - Org Name:986 PHARMACY #8013
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:626-576-0890
Mailing Address - Street 1:103 N GARFIELD AVE.
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3555
Mailing Address - Country:US
Mailing Address - Phone:626-576-0890
Mailing Address - Fax:626-576-0850
Practice Address - Street 1:103 N GARFIELD AVE.
Practice Address - Street 2:SUITE D
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3555
Practice Address - Country:US
Practice Address - Phone:626-576-0890
Practice Address - Fax:626-576-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336L0003X
CAPHY38158333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA381580Medicaid
2033146OtherPK
2033146OtherPK