Healthcare Provider Details

I. General information

NPI: 1720149818
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: 12/12/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 SW 152ND ST
PALMETTO BAY FL
33157-1778
US

IV. Provider business mailing address

9333 SW 152ND ST
PALMETTO BAY FL
33157-1778
US

V. Phone/Fax

Practice location:
  • Phone: 305-256-5182
  • Fax: 305-256-5183
Mailing address:
  • Phone: 305-256-5182
  • Fax: 305-256-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

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