Healthcare Provider Details

I. General information

NPI: 1942634969
Provider Name (Legal Business Name): GASTRO HEALTH, PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 N KENDALL DR SUITE 306W
MIAMI FL
33176-2144
US

IV. Provider business mailing address

8950 N KENDALL DR SUITE 306W
MIAMI FL
33176-2144
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-9966
  • Fax: 305-468-4196
Mailing address:
  • Phone: 305-596-9966
  • Fax: 305-468-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberME70525
License Number StateFL

VIII. Authorized Official

Name: DR. EUGENIO JAVIER HERNANDEZ
Title or Position: PRIMARY PHARMACY PHYSICIAN
Credential: MD
Phone: 305-596-9966