Provider Demographics
NPI:1376143685
Name:METZGER, RICHARD ALLEN SR
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:METZGER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9116 STEINER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6196
Mailing Address - Country:US
Mailing Address - Phone:361-331-4780
Mailing Address - Fax:
Practice Address - Street 1:2801 E INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-8596
Practice Address - Country:US
Practice Address - Phone:817-599-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist