Provider Demographics
NPI:1336811645
Name:BAPTIST HEALTH PHARMACY #107 LLC
Entity Type:Organization
Organization Name:BAPTIST HEALTH PHARMACY #107 LLC
Other - Org Name:BAPTIST HEALTH PHARMACY #107
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-662-7111
Mailing Address - Street 1:6855 S RED RD STE 600
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1228 S PINE ISLAND RD STE 140
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4580
Practice Address - Country:US
Practice Address - Phone:954-377-4679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy