MEDICARE: FLORIDA DEPARTMENT OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336S0011X	Specialty Pharmacy
2	333600000X	Pharmacy	PH6758	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2010924	OTHER		PK

General Provider Information

NPI Number	:	1306868807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DEPARTMENT OF HEALTH

Provider Business Mailing Address
First Line	:	780 SW 24TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2643
Country	:	US
Telephone Number	:	954-467-4700
Fax Number	:	954-467-4393

Provider Business Practice Location Address
First Line	:	2421 SW 6TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33315-2613
Country	:	US
Telephone Number	:	954-467-4875
Fax Number	:	833-320-0368

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	OLGA WYDNER
Credential	:	PHARMD
Telephone Number	:	954-412-7199

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	11/17/2025

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Directions to “FLORIDA DEPARTMENT OF HEALTH ” Practice Location

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