Healthcare Provider Details

I. General information

NPI: 1649703232
Provider Name (Legal Business Name): GASTRO HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 LINTON BLVD 202
DELRAY BEACH FL
33445-6615
US

IV. Provider business mailing address

9500 S DADELAND BLVD 200
MIAMI FL
33156-2824
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-5700
  • Fax: 561-495-2020
Mailing address:
  • Phone: 305-468-4185
  • Fax: 305-675-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BLUM
Title or Position: PRIMARY PHARMACY PHYSICIAN
Credential: MD
Phone: 561-495-5700