Healthcare Provider Details

I. General information

NPI: 1962574723
Provider Name (Legal Business Name): DOUGLAS GARDENS COMMUNITY MENTAL HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 MERIDIAN AVE 4TH FLOOR
MIAMI BEACH FL
33139-2719
US

IV. Provider business mailing address

1680 MERIDIAN AVE SUITE 501
MIAMI BEACH FL
33139-2719
US

V. Phone/Fax

Practice location:
  • Phone: 305-531-5341
  • Fax:
Mailing address:
  • Phone: 305-531-5341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH10854
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH10854
License Number StateFL

VIII. Authorized Official

Name: MARY ELEANOR LANSER
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 305-531-5341