Provider Demographics
NPI:1386974376
Name:ELITE CARE PHARMACY INC
Entity type:Organization
Organization Name:ELITE CARE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUSIK
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVTYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY TECH
Authorized Official - Phone:323-426-9990
Mailing Address - Street 1:5101 SANTA MONICA BLVD
Mailing Address - Street 2:#6
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2478
Mailing Address - Country:US
Mailing Address - Phone:323-426-9990
Mailing Address - Fax:323-522-3611
Practice Address - Street 1:5101 SANTA MONICA BLVD
Practice Address - Street 2:#6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2478
Practice Address - Country:US
Practice Address - Phone:323-426-9990
Practice Address - Fax:323-522-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 545823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 54582OtherCALIFORNIA STATE BOARD OF PHARMACY PERMIT
CAPHY 54582OtherNCPDP NUMBER