Provider Demographics
NPI:1073907838
Name:METRO 2014 PHARMACY, INC
Entity Type:Organization
Organization Name:METRO 2014 PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LADA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATATOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-523-5800
Mailing Address - Street 1:172-17 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-523-5800
Mailing Address - Fax:718-297-4653
Practice Address - Street 1:172-17 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-523-5800
Practice Address - Fax:718-297-4653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0333753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy