MEDICARE: ELITE 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	28375	TX

General Provider Information

NPI Number	:	1932441201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PHARMACY INC

Provider Business Mailing Address
First Line	:	6214 PRESIDIO CANYON DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-8756
Country	:	US
Telephone Number	:	832-419-2101
Fax Number	:	281-578-3524

Provider Business Practice Location Address
First Line	:	11569 S WILCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-4752
Country	:	US
Telephone Number	:	832-419-2101
Fax Number	:	281-578-3524

Authorized Official
Title or Position	:	OFFICE MANAGE
Name	:	EGUONO OGBEVIRE
Credential	:	PHARM D
Telephone Number	:	832-419-2101

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	03/25/2013

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