Provider Demographics
NPI:1598894255
Name:M & I MANAGEMENT, INC.
Entity Type:Organization
Organization Name:M & I MANAGEMENT, INC.
Other - Org Name:METRO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IN
Authorized Official - Middle Name:POM
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-204-1414
Mailing Address - Street 1:4116 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2998
Mailing Address - Country:US
Mailing Address - Phone:718-204-1414
Mailing Address - Fax:718-204-1413
Practice Address - Street 1:4116 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2998
Practice Address - Country:US
Practice Address - Phone:718-204-1414
Practice Address - Fax:718-204-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02867238Medicaid
NY5952590001Medicare NSC