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General NPI Number Information
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NPI Number | 1497200802
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Entity Type | Organization
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Legal Business Name | GASTROCARE LLP
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Dates
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Enumeration Date | 08/16/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 3001 CORAL HILLS DR STE 380A
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4172
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Country | US
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Telephone | 754-702-3836
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Fax | 754-702-3837
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Provider Business Mailing Address
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Address Line | 1620 W NORTHWEST HWY SUITE 100
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City | GRAPEVINE
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State | TX
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Zip | 76051-3177
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Country | US
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Telephone | 817-572-0009
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Fax | 817-720-1039
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Authorized Official
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Title or Position | MANAGER, PHARMACY LICENSING/CONTRAC
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Name | TAMMIE MISKIMINS
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Credential |
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Telephone | 817-572-0009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH30288
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License Number State | FL
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