MEDICARE: ELITE PHARMACY SD CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1497517437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PHARMACY SD CORP

Provider Business Mailing Address
First Line	:	14742 SW 56TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4067
Country	:	US
Telephone Number	:	808-557-7845
Fax Number	:

Provider Business Practice Location Address
First Line	:	14742 SW 56TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4067
Country	:	US
Telephone Number	:	808-557-7845
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. YUSMAIDY ACOSTA
Credential	:
Telephone Number	:	808-557-7845

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

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