Organization
PUBLIC HEALTH TRUST OF DADE COUNTY FLORIDA
Active
Other names
JACKSON MEMORIAL LTC CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE ACOSTA PHARMD, CPH (CONSULTANT PHARMACIST)
(786) 466-3000
Entity
Organization
Contact information
Practice address
2500 NW 22ND AVE, MIAMI, FL 33142-8429
(786) 466-3000
(305) 638-6880
Mailing address
2500 NW 22ND AVE, MIAMI, FL 33142-8429
(786) 466-3000
(305) 638-6880
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PH8034
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1026093
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
103277100
—
FL
Enumeration date
06/22/2006
Last updated
04/18/2012
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