=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750187258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LARKIN COMMUNITY HOSPITAL PALM SPRINGS CAMPUS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2025
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1475 W 49TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-824-4771
-----------------------------------------------------
Fax | 305-824-4758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1475 W 49TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-824-4771
-----------------------------------------------------
Fax | 305-824-4758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY
-----------------------------------------------------
Name | DR. GIJO MATHEW
-----------------------------------------------------
Credential | PHARM.D, MBA, BCPS
-----------------------------------------------------
Telephone | 305-558-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------