Healthcare Provider Details

I. General information

NPI: 1245225010
Provider Name (Legal Business Name): ELITE RX INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W NOBLE AVE
VISALIA CA
93277
US

IV. Provider business mailing address

317 W NOBLE AVE
VISALIA CA
93277
US

V. Phone/Fax

Practice location:
  • Phone: 559-734-6747
  • Fax: 559-734-7932
Mailing address:
  • Phone: 559-734-6747
  • Fax: 559-734-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY 32570
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberPHY32570
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHY32570
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHY32570
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY32570
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberPHY32570
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY32570
License Number StateCA

VIII. Authorized Official

Name: MR. XENGXUE YANG
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 559-734-6747