Provider Demographics
NPI:1689736969
Name:GOLDEN ELITE PHARMACY, INC.
Entity Type:Organization
Organization Name:GOLDEN ELITE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:QUINIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-576-2418
Mailing Address - Street 1:2048 PEPPER ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3162
Mailing Address - Country:US
Mailing Address - Phone:626-576-2418
Mailing Address - Fax:626-576-5804
Practice Address - Street 1:2048 PEPPER ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-576-2418
Practice Address - Fax:626-576-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32301183500000X
310400000X, 3104A0625X, 3104A0630X, 310500000X, 313M00000X, 315P00000X
CA416423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA416420Medicaid