Provider Demographics
NPI:1104097641
Name:GAMMA PROBE CONSULTING CORPORTATION
Entity type:Organization
Organization Name:GAMMA PROBE CONSULTING CORPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:NMT
Authorized Official - Phone:813-629-1188
Mailing Address - Street 1:30273 HOLLY DRIVE USF
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33620-3027
Mailing Address - Country:US
Mailing Address - Phone:813-629-1188
Mailing Address - Fax:866-274-7058
Practice Address - Street 1:30273 HOLLY DRIVE USF
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-3027
Practice Address - Country:US
Practice Address - Phone:813-629-1188
Practice Address - Fax:866-274-7058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL480623336N0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336N0007XSuppliersPharmacyNuclear Pharmacy