Provider Demographics
NPI:1902329840
Name:ELITE RETAIL PHARMACY, INC.
Entity Type:Organization
Organization Name:ELITE RETAIL PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:CONG
Authorized Official - Last Name:VAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:234-631-1173
Mailing Address - Street 1:840 111TH AVE N STE 7
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1868
Mailing Address - Country:US
Mailing Address - Phone:239-631-1173
Mailing Address - Fax:
Practice Address - Street 1:840 111TH AVE N STE 7
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1868
Practice Address - Country:US
Practice Address - Phone:239-631-1173
Practice Address - Fax:239-631-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH308423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy