Healthcare Provider Details

I. General information

NPI: 1679647176
Provider Name (Legal Business Name): PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE PHARMACY ROOM WEST WING B-10
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE PHARMACY ROOM ET BASEMENT 069
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-7458
  • Fax:
Mailing address:
  • Phone: 305-585-7458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number0829
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number0829
License Number StateFL

VIII. Authorized Official

Name: DR. ENEIDA O ROLDAN
Title or Position: PRESIDENT CEO
Credential: M.D.
Phone: 305-585-6754