Provider Demographics
NPI:1275042459
Name:ELONG PHARMACY LLC
Entity Type:Organization
Organization Name:ELONG PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:RUI
Authorized Official - Middle Name:
Authorized Official - Last Name:CUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-988-3998
Mailing Address - Street 1:15415 JEFFREY RD STE 108
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4103
Mailing Address - Country:US
Mailing Address - Phone:949-988-3998
Mailing Address - Fax:949-988-3996
Practice Address - Street 1:15415 JEFFREY RD STE 108
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4103
Practice Address - Country:US
Practice Address - Phone:949-988-3998
Practice Address - Fax:949-988-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55621OtherRETAIL PHARMACY LICENSE