Healthcare Provider Details

I. General information

NPI: 1982240735
Provider Name (Legal Business Name): ELITE RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2282 HAMBURG TPKE STE E
WAYNE NJ
07470-6291
US

IV. Provider business mailing address

2282 HAMBURG TPKE STE E
WAYNE NJ
07470-6291
US

V. Phone/Fax

Practice location:
  • Phone: 862-248-0488
  • Fax: 973-732-5601
Mailing address:
  • Phone: 862-248-0488
  • Fax: 973-732-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DHRUV RALHAN
Title or Position: CHIEF OPERATING OFFICER (COO)
Credential:
Phone: 862-248-0488