Provider Demographics
NPI:1285066977
Name:ELITE PHARMACY, INC
Entity type:Organization
Organization Name:ELITE PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FORESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-248-7234
Mailing Address - Street 1:8100 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2711
Mailing Address - Country:US
Mailing Address - Phone:303-248-7234
Mailing Address - Fax:303-248-7238
Practice Address - Street 1:8100 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2711
Practice Address - Country:US
Practice Address - Phone:303-248-7234
Practice Address - Fax:303-248-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16800000473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22576231Medicaid
CO1680000047OtherBOARD OF PHARMACY