Provider Demographics
NPI:1386148005
Name:GASTRO HEALTH SPECIALTY PHARMACY, LLC
Entity type:Organization
Organization Name:GASTRO HEALTH SPECIALTY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 2:200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2866
Mailing Address - Country:US
Mailing Address - Phone:305-468-4185
Mailing Address - Fax:305-675-3378
Practice Address - Street 1:7500 SW 87TH AVENUE
Practice Address - Street 2:202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3317
Practice Address - Country:US
Practice Address - Phone:305-468-4199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTRO HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015925600OtherMEDICAID NUMBER