MEDICARE: ELIANA PHARMACY INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY60481	OTHER	CA	BOARD OF PHARMACY
2	5636064	OTHER	CA	NCPDP PROVIDER INDENTIFICATION

General Provider Information

NPI Number	:	1649504911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIANA PHARMACY INC

Provider Business Mailing Address
First Line	:	13877 HOLLYWOOD AVE
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	92880-8822
Country	:	US
Telephone Number	:	714-541-8150
Fax Number	:	714-442-8370

Provider Business Practice Location Address
First Line	:	13641 CENTRAL AVE STE E
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5133
Country	:	US
Telephone Number	:	714-541-8150
Fax Number	:	714-442-8370

Authorized Official
Title or Position	:	CEO
Name	:	RAMY MASSOUD
Credential	:
Telephone Number	:	562-708-6863

Provider Enumeration Date	:	09/19/2009
Last Update Date	:	01/30/2025

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Directions to “ELIANA PHARMACY INC ” Practice Location

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