Organization
MID WILSHIRE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN GONG PHARM. D. (PHARMACIST)
(323) 653-6080
Entity
Organization
Contact information
Practice address
6317 WILSHIRE BLVD, LOS ANGELES, CA 90048-5602
(323) 653-6080
(323) 653-2503
Mailing address
6317 WILSHIRE BLVD, LOS ANGELES, CA 90048-5602
(323) 653-6080
(323) 653-2503
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHY36001
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0599273
NABP
—
05
—
PHA360010
—
CA
Enumeration date
11/03/2005
Last updated
08/22/2020
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