Emerald Coast Infectious Diseases Medical Group, PA
Pharmacy, Community/Retail Pharmacy in Fort Walton Beach, FL. Organization (NPI-2).
NPI number1154773950
StatusActive
Last updated in NPPESMar 3, 2025
Details
- NPI
- 1154773950
- Entity type
- Organization (NPI-2)
- Legal business name
- Emerald Coast Infectious Diseases Medical Group, PA
- Organization subpart
- Yes
- Enumeration date
- Jul 6, 2016
- Certification date
- Feb 27, 2025
- Last updated
- Mar 3, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | Yes |
| 333600000X | Pharmacy | PH30219 | FL |
Other names
- Synergy Specialty Pharmacy (Doing Business As)
Practice location
917 Mar Walt DriveSuite D
Fort Walton Beach, FL 32547
Phone 850-312-3570 · Fax 850-312-3090
Mailing address
1620 W. Northwest HwySuite 100
Grapevine, TX 76051
Phone 817-572-0009 · Fax 817-572-0221
Authorized official
Eric Squatrito
Vice President Of Operations
7249778498
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All 7 Community/Retail Pharmacy providers in Fort Walton Beach · All 1,854 providers in Fort Walton Beach
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