Provider Demographics
NPI:1891108379
Name:HMB PHARMACY III MANAGEMENT,LLC
Entity Type:Organization
Organization Name:HMB PHARMACY III 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:RAJESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-318-9629
Mailing Address - Street 1:600 EAST 233RD ST
Mailing Address - Street 2:MONTEFIORE WAKEFIELD HOSPITAL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2668
Mailing Address - Country:US
Mailing Address - Phone:347-346-4570
Mailing Address - Fax:347-346-4571
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:347-346-4570
Practice Address - Fax:347-346-4571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17-032782333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7625330001OtherMEDICARE
NY17-032782OtherSTATE BOARD OF PHARMACY
NY5144743Medicaid