MEDICARE: PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

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	3336C0003X	Community/Retail Pharmacy	PH23949	FL
2	3336S0011X	Specialty Pharmacy
3	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2009220	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790856458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

Provider Business Mailing Address
First Line	:	PO BOX 864938
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-4938
Country	:	US
Telephone Number	:	806-324-5507
Fax Number	:	806-324-5495

Provider Business Practice Location Address
First Line	:	901 NW 17TH ST STE D
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1135
Country	:	US
Telephone Number	:	305-585-3996
Fax Number	:	806-242-0502

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR PHARMACY
Name	:	STEVEN NEMEROFF
Credential	:
Telephone Number	:	305-585-6780

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	02/28/2022

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