Provider Demographics
NPI:1184000622
Name:METRO PHARMACY INC
Entity Type:Organization
Organization Name:METRO PHARMACY INC
Other - Org Name:METRO PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SATYANARAYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-407-5895
Mailing Address - Street 1:620 STANTON CHRISTIANA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2134
Mailing Address - Country:US
Mailing Address - Phone:302-407-5895
Mailing Address - Fax:302-407-3560
Practice Address - Street 1:620 STANTON CHRISTIANA RD STE 102
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2134
Practice Address - Country:US
Practice Address - Phone:302-407-5895
Practice Address - Fax:302-407-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DEA300009893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153848OtherPK
DE1184000622Medicaid