Provider Demographics
NPI:1053679910
Name:NEW METRO PHARMACY
Entity Type:Organization
Organization Name:NEW METRO PHARMACY
Other - Org Name:NEW METRO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RKEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-334-6600
Mailing Address - Street 1:17932 CONANT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-1140
Mailing Address - Country:US
Mailing Address - Phone:313-826-1812
Mailing Address - Fax:313-826-1823
Practice Address - Street 1:17932 CONANT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-1140
Practice Address - Country:US
Practice Address - Phone:313-826-1812
Practice Address - Fax:313-826-1823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010097883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2376716OtherNCPDP PROVIDER IDENTIFICATION NUMBER