Provider Demographics
NPI:1902828908
Name:METCARE RX BUFFALO, INC.
Entity Type:Organization
Organization Name:METCARE RX BUFFALO, INC.
Other - Org Name:METCARE RX CHC BUFFALO
Other - Org Type:Doing Business As
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 1:462 GRIDER ST
Mailing Address - Street 2:DRIVEWAY 1
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3021
Mailing Address - Country:US
Mailing Address - Phone:716-332-6811
Mailing Address - Fax:716-332-6829
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:DRIVEWAY 1
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-332-6811
Practice Address - Fax:716-332-6829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0255143336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02412673Medicaid