Healthcare Provider Details

I. General information

NPI: 1780514778
Provider Name (Legal Business Name): ELITE STERILE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 BERRYWOOD DR
COLUMBIA TN
38401-6408
US

IV. Provider business mailing address

104 BERRYWOOD DR
COLUMBIA TN
38401-6408
US

V. Phone/Fax

Practice location:
  • Phone: 931-901-0021
  • Fax: 931-901-0033
Mailing address:
  • Phone: 931-901-0021
  • Fax: 931-901-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTISON BURKLOW
Title or Position: CEO
Credential:
Phone: 931-626-7261