Provider Demographics
NPI:1790856458
Name:PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Entity Type:Organization
Organization Name:PUBLIC HEALTH TRUST OF MIAMI DADE COUNTY FLORIDA
Other - Org Name:JACKSON PHARMACY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMEROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-585-6780
Mailing Address - Street 1:PO BOX 864938
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4938
Mailing Address - Country:US
Mailing Address - Phone:806-324-5507
Mailing Address - Fax:806-324-5495
Practice Address - Street 1:901 NW 17TH ST STE D
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1135
Practice Address - Country:US
Practice Address - Phone:305-585-3996
Practice Address - Fax:806-242-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
FLPH239493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2009220OtherPK
FL003419201Medicaid
FL003419200Medicaid
FL003419200Medicaid