Healthcare Provider Details

I. General information

NPI: 1285272815
Provider Name (Legal Business Name): GASTRO FLORIDA PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 EXECUTIVE DRIVE SUITE 130
CLEARWATER FL
33762
US

IV. Provider business mailing address

3001 EXECUTIVE DRIVE SUITE 130
CLEARWATER FL
33762
US

V. Phone/Fax

Practice location:
  • Phone: 727-347-0536
  • Fax: 727-329-3377
Mailing address:
  • Phone: 727-347-0536
  • Fax: 727-329-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. SEENA SALYANI
Title or Position: CEO
Credential:
Phone: 727-347-0536