Healthcare Provider Details

I. General information

NPI: 1679509459
Provider Name (Legal Business Name): MIAMI CHILDRENS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 SW 31ST ST
MIAMI FL
33155-3003
US

IV. Provider business mailing address

6125 SW 31ST ST
MIAMI FL
33155-3003
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-7155
  • Fax: 305-669-6564
Mailing address:
  • Phone: 305-669-7155
  • Fax: 305-669-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPH8001
License Number StateFL

VIII. Authorized Official

Name: CONSTANCE CHAN
Title or Position: DIR PCHY SVS
Credential:
Phone: 305-663-8512