Provider Demographics
NPI:1902893837
Name:ELIZABETH PHARMACY, INC
Entity Type:Organization
Organization Name:ELIZABETH PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-421-0114
Mailing Address - Street 1:5041 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15207-1679
Mailing Address - Country:US
Mailing Address - Phone:412-421-0114
Mailing Address - Fax:412-421-1216
Practice Address - Street 1:5041 2ND AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15207-1679
Practice Address - Country:US
Practice Address - Phone:412-421-0114
Practice Address - Fax:412-421-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410683L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005603920002Medicaid
PA3923821OtherNCPDP