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General NPI Number Information
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NPI Number | 1568662625
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Entity Type | Organization
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Legal Business Name | IDEAL RX PHARMACY JACKSON NORTH INC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 16800 NW 2ND AVE STE 100
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-5549
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Country | US
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Telephone | 305-493-0940
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Fax | 305-493-0943
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Provider Business Mailing Address
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Address Line | 16800 NW 2ND AVE STE 100
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-5549
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADRIAN DYETT
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Credential | PHRMD
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Telephone | 954-864-9584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy 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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PH22800
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License Number State | FL
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