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General NPI Number Information
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NPI Number | 1295806727
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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 | 11/13/2006
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 9333 SW 152 STREET
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City | MIAMI
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State | FL
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Zip | 33157
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Country | US
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Telephone | 305-256-5180
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Fax |
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Provider Business Mailing Address
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Address Line | 9333 SW 152 STREET
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City | MIAMI
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State | FL
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Zip | 33157
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Country | US
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Telephone | 305-256-5180
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Fax |
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. ENEIDA O ROLDAN
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Credential | M.D.
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Telephone | 305-585-6754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 17985
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 17986
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License Number State | FL
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