Mid Wilshire Pharmacy

Primary specialty

PharmacyTaxonomy code 333600000X

License

PHY36001 Issued in CA

Legal business name

MID WILSHIRE PHARMACY

Practice address

6317 Wilshire Blvd
Los Angeles, CA 90048-5602

Phone

(323) 653-6080

Fax

(323) 653-2503

NPI assigned

Nov 3, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John Gong, PHARM. D.

Title

Pharmacist

Phone

(323) 653-6080

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013908458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6317 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485602",
            "telephone_number": "323-653-6080",
            "fax_number": "323-653-2503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6317 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485602",
            "telephone_number": "323-653-6080",
            "fax_number": "323-653-2503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID WILSHIRE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GONG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "323-653-6080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM. D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY36001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA360010",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "0599273",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krishuna S Mickens
• Mickey Fine Enterprises Inc
• Paola Micozzi, CMT
• Mid City Associated Medical Group, Inc.
• Mid Wilshire Hospice
• Mid-Valley Imaging, LLC
• Mid-Wilshire Health Care Center
• Mid-Wilshire Surgery Center,LLC
• Erica Miday
• Angela Michelle Middlebrook

• Pharmacy in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.