Provider Demographics
NPI:1053696880
Name:ELITE RX, LLC
Entity type:Organization
Organization Name:ELITE RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:ROBNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-522-1559
Mailing Address - Street 1:135 GEMINI CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5842
Mailing Address - Country:US
Mailing Address - Phone:205-945-6705
Mailing Address - Fax:205-945-6703
Practice Address - Street 1:135 GEMINI CIR STE 201
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5842
Practice Address - Country:US
Practice Address - Phone:205-945-6705
Practice Address - Fax:205-945-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1138163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL113816OtherSTATE PERMIT