Provider Demographics
NPI:1043533375
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 1:322 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-1017
Mailing Address - Country:US
Mailing Address - Phone:585-254-6480
Mailing Address - Fax:585-672-1737
Practice Address - Street 1:322 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1017
Practice Address - Country:US
Practice Address - Phone:585-254-6480
Practice Address - Fax:585-672-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0298643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03205718Medicaid
3364661OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3364661OtherNCPDP PROVIDER IDENTIFICATION NUMBER