Healthcare Provider Details

I. General information

NPI: 1215026000
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 NW 6TH AVE
POMPANO BEACH FL
33060-5908
US

IV. Provider business mailing address

780 SW 24TH ST
FORT LAUDERDALE FL
33315-2643
US

V. Phone/Fax

Practice location:
  • Phone: 954-467-4445
  • Fax: 833-320-3834
Mailing address:
  • Phone: 954-467-4700
  • Fax: 954-467-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License NumberPH13685
License Number StateFL

VIII. Authorized Official

Name: OLGA N WYDNER
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD
Phone: 954-412-7199