Healthcare Provider Details

I. General information

NPI: 1891084075
Provider Name (Legal Business Name): METRO RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 E COLONIAL DR
ORLANDO FL
32803-4307
US

IV. Provider business mailing address

4809 E COLONIAL DR
ORLANDO FL
32803-4307
US

V. Phone/Fax

Practice location:
  • Phone: 407-668-4945
  • Fax: 407-704-1469
Mailing address:
  • Phone: 407-668-4945
  • Fax: 407-704-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25368
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH25368
License Number StateFL

VIII. Authorized Official

Name: OMAR ZOOBI
Title or Position: MEMBER/MANAGER
Credential: RPH
Phone: 407-668-4945