Provider Demographics
NPI:1518357599
Name:GASTRO HEALTH SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:GASTRO HEALTH SPECIALTY PHARMACY, LLC
Other - Org Name:GASTRO HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-913-0666
Mailing Address - Street 1:9500 S DADELAND BLVD
Mailing Address - Street 2:SUITE 802
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2824
Mailing Address - Country:US
Mailing Address - Phone:305-913-0666
Mailing Address - Fax:306-913-0663
Practice Address - Street 1:7500 SW 87TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5426
Practice Address - Country:US
Practice Address - Phone:305-468-4199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH288493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy