Healthcare Provider Details

I. General information

NPI: 1760418545
Provider Name (Legal Business Name): THE JEROME GOLDEN CENTER FOR BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 45TH ST
WEST PALM BEACH FL
33407-2402
US

IV. Provider business mailing address

1041 45TH ST
WEST PALM BEACH FL
33407-2402
US

V. Phone/Fax

Practice location:
  • Phone: 561-383-5706
  • Fax: 561-514-1965
Mailing address:
  • Phone: 561-383-5706
  • Fax: 561-514-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPH1868
License Number StateFL

VIII. Authorized Official

Name: THANH LE
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 561-383-5765