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General NPI Number Information
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NPI Number | 1104116573
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Entity Type | Organization
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Legal Business Name | FLORIDA DEPARTMENT OF HEALTH IN MIAMI-DADE COUNTY
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 2515 W FLAGLER STREET 102-A
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City | MIAMI
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State | FL
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Zip | 33135
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Country | US
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Telephone | 305-643-7400
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Fax | 305-643-7401
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Provider Business Mailing Address
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Address Line | 2515 W FLAGLER STREET 102-A
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City | MIAMI
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State | FL
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Zip | 33135
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Country | US
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Telephone | 305-643-7400
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Fax | 305-643-7401
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Authorized Official
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Title or Position | REVENUE ADMINISTRATOR
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Name | PATRICIA BUSTAMANTE
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Credential |
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Telephone | 786-845-0164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH7456
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License Number State | FL
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