Provider Demographics
NPI:1063283893
Name:ELITEMED, INC.
Entity type:Organization
Organization Name:ELITEMED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADRINEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHISH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:747-600-9555
Mailing Address - Street 1:10515 BALBOA BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6354
Mailing Address - Country:US
Mailing Address - Phone:747-600-9555
Mailing Address - Fax:747-600-8866
Practice Address - Street 1:10515 BALBOA BLVD STE 125
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6354
Practice Address - Country:US
Practice Address - Phone:747-600-9555
Practice Address - Fax:747-600-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY59196OtherBOARD OF PHARMACY