Healthcare Provider Details

I. General information

NPI: 1891608915
Provider Name (Legal Business Name): META SPECIALTY PHARMACY RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 METCALF AVE
BRONX NY
10472-2867
US

IV. Provider business mailing address

1230 METCALF AVE
BRONX NY
10472-2867
US

V. Phone/Fax

Practice location:
  • Phone: 646-201-9061
  • Fax: 646-201-9062
Mailing address:
  • Phone: 646-201-9061
  • Fax: 646-201-9062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: SYED RAHMAN
Title or Position: PIC
Credential:
Phone: 646-201-9061