Provider Demographics
NPI:1912667502
Name:JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC
Other - Org Name:FLAMINGO PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEASMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-805-1700
Mailing Address - Street 1:5607 NW 27TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-2826
Mailing Address - Country:US
Mailing Address - Phone:305-805-1700
Mailing Address - Fax:
Practice Address - Street 1:901 E 10TH AVE STE 39
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3766
Practice Address - Country:US
Practice Address - Phone:305-805-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH33639OtherSTATE PHARMACY LICENSE