Provider Demographics
NPI:1407482730
Name:ELITE CLINICAL CARE PHARMACY INC
Entity Type:Organization
Organization Name:ELITE CLINICAL CARE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GABRIELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-724-8111
Mailing Address - Street 1:9103 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3920
Mailing Address - Country:US
Mailing Address - Phone:818-724-8111
Mailing Address - Fax:818-875-2057
Practice Address - Street 1:9103 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-3920
Practice Address - Country:US
Practice Address - Phone:818-724-8111
Practice Address - Fax:818-875-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57477OtherBOARD OF PHARMACY PERMIT