Provider Demographics
NPI:1568662625
Name:IDEAL RX PHARMACY JACKSON NORTH INC
Entity type:Organization
Organization Name:IDEAL RX PHARMACY JACKSON NORTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DYETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:954-864-9584
Mailing Address - Street 1:16800 NW 2ND AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16800 NW 2ND AVE
Practice Address - Street 2:STE 100
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5549
Practice Address - Country:US
Practice Address - Phone:305-493-0940
Practice Address - Fax:305-493-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336H0001X
FLPH228003336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1027780OtherOTHER ID NUMBER