Provider Demographics
NPI:1003139270
Name:HMB PHARMACY MANAGEMENT LLC
Entity Type:Organization
Organization Name:HMB PHARMACY MANAGEMENT LLC
Other - Org Name:METCARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-318-9628
Mailing Address - Street 1:462 GRIDER ST
Mailing Address - Street 2:DRIVEWAY 3
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-332-2866
Mailing Address - Fax:716-332-2880
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:DRIVEWAY 3
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-332-2866
Practice Address - Fax:716-332-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0298663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03198203Medicaid
3364774OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY6386130003Medicare NSC