1790856458 NPI number — PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

Table of content: (NPI 1790856458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790856458 NPI number — PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JACKSON PHARMACY SOLUTIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790856458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 NW 17TH ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-585-3996
Provider Business Practice Location Address Fax Number:
806-242-0502
Provider Enumeration Date:
11/13/2006

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X , with the licence number: PH23949 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2009220 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003419201 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003419200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".