Provider Demographics
NPI:1790720977
Name:METCARE RX ORANGE CITY PHARM SVC
Entity Type:Organization
Organization Name:METCARE RX ORANGE CITY PHARM SVC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP CORP REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-653-1040
Mailing Address - Street 1:2742 ENTERPRISE RD
Mailing Address - Street 2:B
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2742 ENTERPRISE RD
Practice Address - Street 2:B
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8353
Practice Address - Country:US
Practice Address - Phone:386-775-2255
Practice Address - Fax:386-775-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH208353336C0002X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0002XSuppliersPharmacyClinic Pharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1096026OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5631570001Medicare ID - Type Unspecified