Healthcare Provider Details

I. General information

NPI: 1750187258
Provider Name (Legal Business Name): LARKIN COMMUNITY HOSPITAL PALM SPRINGS CAMPUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 W 49TH ST
HIALEAH FL
33012-3222
US

IV. Provider business mailing address

1475 W 49TH ST
HIALEAH FL
33012-3222
US

V. Phone/Fax

Practice location:
  • Phone: 305-824-4771
  • Fax: 305-824-4758
Mailing address:
  • Phone: 305-824-4771
  • Fax: 305-824-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. GIJO MATHEW
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARM.D, MBA, BCPS
Phone: 305-558-2500