Healthcare Provider Details

I. General information

NPI: 1386148005
Provider Name (Legal Business Name): GASTRO HEALTH SPECIALTY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 SW 87TH AVENUE 202
MIAMI FL
33173-3317
US

IV. Provider business mailing address

9500 S DADELAND BLVD 200
MIAMI FL
33156-2866
US

V. Phone/Fax

Practice location:
  • Phone: 305-468-4199
  • Fax:
Mailing address:
  • Phone: 305-468-4185
  • Fax: 305-675-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES LEAVITT
Title or Position: PRESIDENT
Credential: MD
Phone: 305-913-0666