Provider Demographics
NPI:1790081297
Name:MIAMI BEACH COMMUNITY HEALTH CENTER PHARMACY INC
Entity type:Organization
Organization Name:MIAMI BEACH COMMUNITY HEALTH CENTER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RABINOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-538-8835
Mailing Address - Street 1:11645 BISCAYNE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3138
Mailing Address - Country:US
Mailing Address - Phone:305-538-8835
Mailing Address - Fax:305-695-2168
Practice Address - Street 1:11645 BISCAYNE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3138
Practice Address - Country:US
Practice Address - Phone:305-538-8835
Practice Address - Fax:305-695-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH253803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004242000Medicaid
2128801OtherPK