Healthcare Provider Details

I. General information

NPI: 1710743471
Provider Name (Legal Business Name): ELITE RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 S RAINBOW BLVD STE 403
LAS VEGAS NV
89103-4750
US

IV. Provider business mailing address

5960 THIROS CIRCLE
LAS VEGAS NV
89146
US

V. Phone/Fax

Practice location:
  • Phone: 702-538-9388
  • Fax: 702-776-8982
Mailing address:
  • Phone: 702-673-2216
  • Fax: 702-768-8982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY S LANG
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 702-538-9388