Provider Demographics
NPI:1568785897
Name:HMB PHARMACY MANAGEMENT LLC
Entity Type:Organization
Organization Name:HMB PHARMACY MANAGEMENT LLC
Other - Org Name:METCARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-318-9628
Mailing Address - Street 1:1 FORDHAM PLZ
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5871
Mailing Address - Country:US
Mailing Address - Phone:718-741-9505
Mailing Address - Fax:718-741-9525
Practice Address - Street 1:1 FORDHAM PLZ
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5871
Practice Address - Country:US
Practice Address - Phone:718-741-9505
Practice Address - Fax:718-741-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0298723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124309OtherPK
NY3195448Medicaid