Organization
FLORIDA DEPARTMENTOF CHILDREN AND FAMILIES
Active
Other names
S FL STATE HOSP
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE FUNSTON (HOSP ADMIN)
(954) 392-3050
Entity
Organization
Contact information
Practice address
800 E CYPRESS DR, PEMBROKE PINES, FL 33025-4543
(954) 392-3027
(954) 392-3468
Mailing address
1317 WINEWOOD BLVD BLDG 2, OFFICE OF REVENUE MANAGEMENT, ATTN: VELMA BRYANT, TALLAHASSEE, FL 32399-0700
(850) 921-8749
(954) 392-3468
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH16231
FL
3336I0012X
Institutional Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026004500
—
FL
01
—
1018109
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/22/2006
Last updated
03/08/2010
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