=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467726182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH BROWARD HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2012
-----------------------------------------------------
Last Update Date | 08/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7800 SHERIDAN ST 2ND FLOOR - MAIN PHARMACY
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-2536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-883-8008
-----------------------------------------------------
Fax | 954-883-7040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7800 SHERIDAN ST 2ND FLOOR - MAIN PHARMACY
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-2536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-883-8008
-----------------------------------------------------
Fax | 954-883-7040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | MR. VISHWAS J DAVE
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 954-883-8007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH13454
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------