Provider Demographics
NPI:1508337510
Name:WISE CARE PHARMACY INC
Entity Type:Organization
Organization Name:WISE CARE PHARMACY INC
Other - Org Name:WISE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ATIT
Authorized Official - Middle Name:RAJESH
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-461-3099
Mailing Address - Street 1:8980 KNOTT AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4137
Mailing Address - Country:US
Mailing Address - Phone:714-461-3099
Mailing Address - Fax:
Practice Address - Street 1:8980 KNOTT AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4137
Practice Address - Country:US
Practice Address - Phone:323-484-2953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0048142Medicaid