=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306868807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA DEPARTMENT OF HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 11/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2421 SW 6TH AVE
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33315-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-467-4875
-----------------------------------------------------
Fax | 833-320-0368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 780 SW 24TH ST
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33315-2643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-467-4700
-----------------------------------------------------
Fax | 954-467-4393
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | OLGA WYDNER
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 954-412-7199
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PH6758
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------