Provider Demographics
NPI:1255643011
Name:GAMA PRESCRIPTION MANAGEMENT LLC
Entity type:Organization
Organization Name:GAMA PRESCRIPTION MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:BHAVESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-732-0356
Mailing Address - Street 1:2234 BAUER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1996
Mailing Address - Country:US
Mailing Address - Phone:513-732-0356
Mailing Address - Fax:513-732-0459
Practice Address - Street 1:2234 BAUER RD STE A
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1996
Practice Address - Country:US
Practice Address - Phone:513-732-0356
Practice Address - Fax:513-732-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X
OH0220622503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125677OtherPK
OH3060173Medicaid