Provider Demographics
NPI:1922103142
Name:WILSHIRE PHARMCARE, INC.
Entity Type:Organization
Organization Name:WILSHIRE PHARMCARE, INC.
Other - Org Name:ADVANCED PHARMACY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:KYONG YOL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:323-295-5585
Mailing Address - Street 1:26611 CABOT RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7031
Mailing Address - Country:US
Mailing Address - Phone:949-348-7900
Mailing Address - Fax:949-348-7922
Practice Address - Street 1:26611 CABOT RD STE B
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7031
Practice Address - Country:US
Practice Address - Phone:949-348-7900
Practice Address - Fax:949-348-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336H0001X
CAPHY55921333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1922103142Medicaid
NM27874737Medicaid
AZ474253Medicaid
AK1692434Medicaid
CO1922103142Medicaid
CA0547185OtherNCPDP NUMBER
WA2104940Medicaid
UT1922103142Medicaid
CAZZZ56233ZOtherBLUE SHIELD
CA1922103142Medicaid
MT1922103142Medicaid