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General NPI Number Information
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NPI Number | 1053696880
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Entity Type | Organization
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Legal Business Name | ELITE RX, LLC
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 135 GEMINI CIR STE 201
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City | BIRMINGHAM
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State | AL
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Zip | 35209-5842
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Country | US
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Telephone | 205-945-6705
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Fax | 205-945-6703
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Provider Business Mailing Address
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Address Line | 135 GEMINI CIR STE 201
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City | BIRMINGHAM
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State | AL
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Zip | 35209-5842
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Country | US
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Telephone | 205-945-6705
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Fax | 205-945-6703
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. DANIEL RYAN ROBNETT
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Credential |
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Telephone | 205-522-1559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 113816
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License Number State | AL
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