Provider Demographics
NPI:1417288614
Name:METRO PHARMACY
Entity Type:Organization
Organization Name:METRO PHARMACY
Other - Org Name:METRO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BADR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-668-4368
Mailing Address - Street 1:318 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1109
Mailing Address - Country:US
Mailing Address - Phone:407-668-4945
Mailing Address - Fax:407-704-1469
Practice Address - Street 1:318 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1109
Practice Address - Country:US
Practice Address - Phone:407-668-4945
Practice Address - Fax:407-704-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336M0002X, 3336C0004X
FLPH245603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124438OtherPK
FL002352300Medicaid