Provider Demographics
NPI:1891728580
Name:METCARE RX ORMOND BEACH PHARMACEUTICAL SERVICES, LLC
Entity Type:Organization
Organization Name:METCARE RX ORMOND BEACH PHARMACEUTICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP CORPORATE 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 1:1200 W GRANADA BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8156
Mailing Address - Country:US
Mailing Address - Phone:386-673-2210
Mailing Address - Fax:386-676-9223
Practice Address - Street 1:1200 W GRANADA BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8156
Practice Address - Country:US
Practice Address - Phone:386-673-2210
Practice Address - Fax:386-676-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH201163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy