Provider Demographics
NPI:1114387966
Name:GASTRO HEALTH, PL
Entity Type:Organization
Organization Name:GASTRO HEALTH, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY PHARMACY PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:305-856-7333
Mailing Address - Street 1:9500 S DADELAND BLVD
Mailing Address - Street 2:STE 802
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2824
Mailing Address - Country:US
Mailing Address - Phone:305-468-4185
Mailing Address - Fax:305-675-3378
Practice Address - Street 1:3661 S MIAMI AVE STE 907
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4214
Practice Address - Country:US
Practice Address - Phone:305-856-7333
Practice Address - Fax:305-675-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008258300Medicaid
FLQ0398Medicare PIN