Provider Demographics
NPI:1114647369
Name:METAMTMHEALTH
Entity Type:Organization
Organization Name:METAMTMHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HANJAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:503-229-3555
Mailing Address - Street 1:12250 SW CANYON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2116
Mailing Address - Country:US
Mailing Address - Phone:971-229-3555
Mailing Address - Fax:971-203-7522
Practice Address - Street 1:12250 SW CANYON RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2116
Practice Address - Country:US
Practice Address - Phone:971-229-3555
Practice Address - Fax:971-203-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy