Healthcare Provider Details

I. General information

NPI: 1053789313
Provider Name (Legal Business Name): PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

PO BOX 864781
ORLANDO FL
32886-4781
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5890
  • Fax: 806-242-0502
Mailing address:
  • Phone: 806-324-5507
  • Fax: 806-324-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPH0008215
License Number StateFL

VIII. Authorized Official

Name: JAN ROBINSON
Title or Position: VP-CONTRACTING
Credential:
Phone: 806-324-5507