1689951717 NPI number — METROHEALTH PHARMACY LLC

Table of content: (NPI 1689951717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689951717 NPI number — METROHEALTH PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROHEALTH PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
METROHEALTH PHARMACY LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689951717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5543 MYRTLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11385-3503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-668-4945
Provider Business Mailing Address Fax Number:
407-704-1469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5543 MYRTLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385-3503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-889-7086
Provider Business Practice Location Address Fax Number:
347-889-7089
Provider Enumeration Date:
11/03/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BADR
Authorized Official First Name:
ASHRAF
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER/MANAGER
Authorized Official Telephone Number:
321-438-0129

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 030979 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2132828 . This is a "PK" identifier . This identifiers is of the category "OTHER".