Organization
IDEAL RX PHARMACY JACKSON NORTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIAN DYETT PHRMD (PRESIDENT)
(954) 864-9584
Entity
Organization
Contact information
Practice address
16800 NW 2ND AVE, STE 100, NORTH MIAMI BEACH, FL 33169-5549
(305) 493-0940
(305) 493-0943
Mailing address
16800 NW 2ND AVE, STE 100, NORTH MIAMI BEACH, FL 33169-5549
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
PH22800
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1027780
OTHER ID NUMBER
—
Enumeration date
07/18/2007
Last updated
04/09/2008
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