1013914217 NPI number — ELITE PHARMACY, INC.

Table of content: (NPI 1013914217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013914217 NPI number — ELITE PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE PHARMACY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013914217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10017 JEFFERSON HWY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
RIVER RIDGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70123-2471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-737-2212
Provider Business Mailing Address Fax Number:
504-737-2272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10017 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RIVER RIDGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70123-2471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-737-2212
Provider Business Practice Location Address Fax Number:
504-737-2272
Provider Enumeration Date:
07/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ALBERTO
Authorized Official First Name:
AMAURY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
504-737-2212

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5472-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BN1400X , with the licence number: 5472-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BP3500X , with the licence number: 5472-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BX2000X , with the licence number: 5472-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 333600000X , with the licence number: 5472-IR , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14-156223 . This is a "JEFF PARISH OCCUP. LICENS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: C005472-IR . This is a "LABP CDS PERMIT NO." identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1932107 . This is a "NCPDP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5472-IR . This is a "LABP PERMIT NO." identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1274771 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 545055-2 . This is a "DEPT OF LABOR NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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