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General NPI Number Information
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NPI Number | 1962592915
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Entity Type | Organization
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Legal Business Name | CITRUS HEALTH NETWORK, INC.
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 4175 W 20TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-5874
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Country | US
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Telephone | 305-424-3177
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Fax | 305-556-2580
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Provider Business Mailing Address
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Address Line | 4175 W 20TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-5874
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Country | US
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Telephone | 305-825-0300
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Fax | 305-556-2580
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Authorized Official
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Title or Position | CEO
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Name | MARIO JARDON
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Credential |
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Telephone | 305-825-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | PH8703
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License Number State | FL
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