Provider Demographics
NPI:1417508789
Name:ELITE APOTHECARY SERVICES, LLC
Entity Type:Organization
Organization Name:ELITE APOTHECARY SERVICES, LLC
Other - Org Name:PRIMARY PEDIATRICS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-340-2456
Mailing Address - Street 1:PO BOX 10426
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-5426
Mailing Address - Country:US
Mailing Address - Phone:478-749-9120
Mailing Address - Fax:
Practice Address - Street 1:5300 BOWMAN ROAD RM A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-6583
Practice Address - Country:US
Practice Address - Phone:478-749-9120
Practice Address - Fax:478-749-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003225637AMedicaid