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NPI Code Detail

MEDICARE: ELITE ACCESS PHARMACY INC

MEDICARE: ELITE ACCESS PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy5301010389MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12144354OTHERPK

General Provider Information

NPI Number : 1699198606
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELITE ACCESS PHARMACY INC
Provider Business Mailing Address
First Line : 6450 MAPLE ST
Second Line :
City : DEARBORN
State : MI
Zip : 48126-2259
Country : US
Telephone Number : 313-216-2213
Fax Number : 313-584-3249
Provider Business Practice Location Address
First Line : 6450 MAPLE ST
Second Line :
City : DEARBORN
State : MI
Zip : 48126-2259
Country : US
Telephone Number : 313-216-2213
Fax Number : 313-584-3249
Authorized Official
Title or Position : OWNER
Name : TAREK JAWARD
Credential :
Telephone Number : 313-674-9800
Provider Enumeration Date : 01/27/2014
Last Update Date : 06/05/2015

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Directions to “ELITE ACCESS PHARMACY INC ” Practice Location

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