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General NPI Number Information
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NPI Number | 1053789313
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Entity Type | Organization
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Legal Business Name | PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-585-5890
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Fax | 806-242-0502
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Provider Business Mailing Address
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Address Line | PO BOX 864781
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City | ORLANDO
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State | FL
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Zip | 32886-4781
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Country | US
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Telephone | 806-324-5507
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Fax | 806-324-5495
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Authorized Official
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Title or Position | VP-CONTRACTING
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Name | JAN ROBINSON
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Credential |
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Telephone | 806-324-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | PH0008215
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License Number State | FL
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