Healthcare Provider Details

I. General information

NPI: 1366375651
Provider Name (Legal Business Name): ELITE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 MICHIGAN AVE STE 2
DEARBORN MI
48126-3491
US

IV. Provider business mailing address

15400 MICHIGAN AVE STE 2
DEARBORN MI
48126-3491
US

V. Phone/Fax

Practice location:
  • Phone: 313-663-0088
  • Fax:
Mailing address:
  • Phone: 313-663-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HANAN ELSIBAI
Title or Position: OWNER/PIC
Credential: PHARMD
Phone: 313-663-0088