Provider Demographics
NPI:1245225010
Name:ELITE RX INC.
Entity Type:Organization
Organization Name:ELITE RX INC.
Other - Org Name:PILL BOX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:XENGXUE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:559-734-6747
Mailing Address - Street 1:317 W NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277
Mailing Address - Country:US
Mailing Address - Phone:559-734-6747
Mailing Address - Fax:559-734-7932
Practice Address - Street 1:317 W NOBLE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-734-6747
Practice Address - Fax:559-734-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY325701835N1003X, 332B00000X, 332BN1400X, 332BP3500X, 333600000X, 3336C0003X
CAPHY 325703336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No1835N1003XPharmacy Service ProvidersPharmacistNutrition SupportGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY49144OtherPHARMACY PERMIT NUMBER
CA1891797387OtherNPI INDIVUAL NUMBER
CA0521903OtherNCPDP
CA1245225010Medicaid
CA6480940001Medicare NSC