Healthcare Provider Details

I. General information

NPI: 1790148682
Provider Name (Legal Business Name): GASTRO HEALTH, PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 SW 87TH AVE 212
MIAMI FL
33173-2596
US

IV. Provider business mailing address

9500 S DADELAND BLVD STE 802
MIAMI FL
33156-2824
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-3080
  • Fax: 305-675-3378
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 NumberME72681
License Number StateFL

VIII. Authorized Official

Name: MARCOS SZOMSTEIN
Title or Position: PRIMARY PHARMACY PHYSICIAN
Credential: MD
Phone: 305-596-3080