Provider Demographics
NPI:1396221867
Name:GATUS ENTERPRISE, PLLC
Entity Type:Organization
Organization Name:GATUS ENTERPRISE, PLLC
Other - Org Name:BROADWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:APPIAHENE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:407-750-5999
Mailing Address - Street 1:22 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5408
Mailing Address - Country:US
Mailing Address - Phone:407-750-5999
Mailing Address - Fax:407-750-5002
Practice Address - Street 1:22 BROADWAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5408
Practice Address - Country:US
Practice Address - Phone:407-750-5999
Practice Address - Fax:407-750-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH31537333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH31537OtherPHARMACY LICENSE