Provider Demographics
NPI:1790923043
Name:ELITE PHARMACY
Entity Type:Organization
Organization Name:ELITE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:DURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-681-5483
Mailing Address - Street 1:3044 ANTOINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-7053
Mailing Address - Country:US
Mailing Address - Phone:713-681-5483
Mailing Address - Fax:713-681-5489
Practice Address - Street 1:3044 ANTOINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-7053
Practice Address - Country:US
Practice Address - Phone:713-681-5483
Practice Address - Fax:713-681-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-24
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34302333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy