=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518357599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASTRO HEALTH SPECIALTY PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2015
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4820 SW 72ND AVENUE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-468-4199
-----------------------------------------------------
Fax | 786-621-7214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1620 W. NORTHWEST HWY SUITE 100
-----------------------------------------------------
City | GRAPEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-572-0009
-----------------------------------------------------
Fax | 817-572-0221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | LAWRENCE (LARRY) FRENI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-620-6399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH28849
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------