Healthcare Provider Details

I. General information

NPI: 1720804693
Provider Name (Legal Business Name): ELIXIR RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13752 FOOTHILL BLVD
SYLMAR CA
91342-3193
US

IV. Provider business mailing address

PO BOX 920070
SYLMAR CA
91392-0070
US

V. Phone/Fax

Practice location:
  • Phone: 818-474-5750
  • Fax: 818-474-5740
Mailing address:
  • Phone: 818-474-5750
  • Fax: 818-474-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMER JAWICH
Title or Position: PIC
Credential: RPH
Phone: 818-474-5750