Provider Demographics
NPI:1184258824
Name:METROPOLITIAN AUSTIN OUTPATIENT PHARMACY LLC
Entity type:Organization
Organization Name:METROPOLITIAN AUSTIN OUTPATIENT PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-459-1577
Mailing Address - Street 1:645 S CENTRAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-5059
Mailing Address - Country:US
Mailing Address - Phone:773-854-2500
Mailing Address - Fax:773-854-2600
Practice Address - Street 1:645 S CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-5059
Practice Address - Country:US
Practice Address - Phone:773-854-2500
Practice Address - Fax:773-854-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054.021290OtherPHARMACY LICENSE NO.
IL054.021290OtherPHARMACY LICENSE NO.