Healthcare Provider Details

I. General information

NPI: 1104116573
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH IN MIAMI-DADE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 W FLAGLER STREET 102-A
MIAMI FL
33135
US

IV. Provider business mailing address

2515 W FLAGLER STREET 102-A
MIAMI FL
33135
US

V. Phone/Fax

Practice location:
  • Phone: 305-643-7400
  • Fax: 305-643-7401
Mailing address:
  • Phone: 305-643-7400
  • Fax: 305-643-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH7456
License Number StateFL

VIII. Authorized Official

Name: PATRICIA BUSTAMANTE
Title or Position: REVENUE ADMINISTRATOR
Credential:
Phone: 786-845-0164