Provider Demographics
NPI:1750484705
Name:METTIAS, MEDHAT A (RPH)
Entity Type:Individual
Prefix:
First Name:MEDHAT
Middle Name:A
Last Name:METTIAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2516
Mailing Address - Country:US
Mailing Address - Phone:561-998-0817
Mailing Address - Fax:
Practice Address - Street 1:1620 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6901
Practice Address - Country:US
Practice Address - Phone:561-736-4456
Practice Address - Fax:561-736-3657
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0029092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050496Medicare ID - Type Unspecified
FL1000645Medicare UPIN