Provider Demographics
NPI:1114375748
Name:HMB IV PHARMACY MANAGEMENT LLC
Entity Type:Organization
Organization Name:HMB IV PHARMACY MANAGEMENT LLC
Other - Org Name:METCARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
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 1:1250 WATERS PL
Mailing Address - Street 2:TOWER II
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2720
Mailing Address - Country:US
Mailing Address - Phone:718-975-7774
Mailing Address - Fax:718-975-7776
Practice Address - Street 1:1250 WATERS PL
Practice Address - Street 2:TOWER II
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2720
Practice Address - Country:US
Practice Address - Phone:718-975-7774
Practice Address - Fax:718-975-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
NY0345773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4752549Medicaid
NY7602020001OtherMEDICARE
2160312OtherPK