=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437594975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SND HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2013
-----------------------------------------------------
Last Update Date | 05/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 NE 54TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33137-2434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-613-2258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 E LAS OLAS BLVD STE 130376
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33301-2210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-613-2258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. CHERESE N JONES
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 905-613-2258
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH26830
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------