Healthcare Provider Details

I. General information

NPI: 1568578367
Provider Name (Legal Business Name): PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NW 17TH ST
MIAMI FL
33136-1135
US

IV. Provider business mailing address

PO BOX 12493
MIAMI FL
33101-2493
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5890
  • Fax: 305-585-0088
Mailing address:
  • Phone: 305-585-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH0008215
License Number StateFL

VIII. Authorized Official

Name: MARK T KNIGHT
Title or Position: EVP CHIEF FINANCIAL OFFICER
Credential:
Phone: 305-585-7979