Healthcare Provider Details

I. General information

NPI: 1790856458
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: 11/13/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NW 17TH ST STE D
MIAMI FL
33136-1135
US

IV. Provider business mailing address

PO BOX 864938
ORLANDO FL
32886-4938
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-3996
  • Fax: 806-242-0502
Mailing address:
  • Phone: 806-324-5507
  • Fax: 806-324-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23949
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVEN NEMEROFF
Title or Position: ASSOCIATE DIRECTOR PHARMACY
Credential:
Phone: 305-585-6780