Healthcare Provider Details

I. General information

NPI: 1306868807
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 SW 6TH AVE
FT LAUDERDALE FL
33315-2613
US

IV. Provider business mailing address

780 SW 24TH ST
FORT LAUDERDALE FL
33315-2643
US

V. Phone/Fax

Practice location:
  • Phone: 954-467-4875
  • Fax: 833-320-0368
Mailing address:
  • Phone: 954-467-4700
  • Fax: 954-467-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH6758
License Number StateFL

VIII. Authorized Official

Name: OLGA WYDNER
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 954-412-7199