Provider Demographics
NPI:1275030389
Name:MEDLOGS INC.
Entity Type:Organization
Organization Name:MEDLOGS INC.
Other - Org Name:METRIX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SOPURUCHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NWANKWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-814-0720
Mailing Address - Street 1:2121 W PARMER LN #103C
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727
Mailing Address - Country:US
Mailing Address - Phone:512-814-0720
Mailing Address - Fax:512-814-0721
Practice Address - Street 1:2121 W PARMER LN STE 103C
Practice Address - Street 2:#103C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4351
Practice Address - Country:US
Practice Address - Phone:512-814-0720
Practice Address - Fax:512-814-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319093336C0003X, 3336C0003X
3336L0003X, 3336M0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176903OtherPK
TX149799Medicaid