Organization
PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Active
Other names
JACKSON MEMORIAL HOSPITAL OUTPATIENT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK T KNIGHT (EVP CHIEF FINANCIAL OFFICER)
(305) 585-7979
Entity
Organization
Contact information
Practice address
901 NW 17TH ST, MIAMI, FL 33136-1135
(305) 585-5890
(305) 585-0088
Mailing address
PO BOX 12493, MIAMI, FL 33101-2493
(305) 585-5315
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH0008215
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109498000
—
FL
05
—
109498001
—
FL
01
—
2011957
PK
—
Enumeration date
08/22/2006
Last updated
04/05/2024
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