Healthcare Provider Details

I. General information

NPI: 1447271002
Provider Name (Legal Business Name): METCARE RX BUFFALO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST SUSSEX STREET ENTRANCE
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

462 GRIDER ST SUSSEX STREET ENTRANCE
BUFFALO NY
14215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 716-332-2866
  • Fax: 716-332-2880
Mailing address:
  • Phone: 716-332-2866
  • Fax: 716-332-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number025521
License Number StateNY

VIII. Authorized Official

Name: GINA HUNT
Title or Position: SENIOR VP CORPORATE REVENUE
Credential:
Phone: 954-653-1040