EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, PA (NPI# 1154773950) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154773950 |
| Entity Type | Organization |
| Organization Name | EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, PA |
| Other Organization Name | SYNERGY SPECIALTY PHARMACY |
| Practice Address |
917 Mar Walt Dr Ste C Fort Walton Beach FL 32547-6651 |
| Mailing Address |
1620 W. Northwest Hwy Suite 100 Grapevine TX 76051 |
| Practice Telephone | 8175720009 |
| Practice Fax Number | 8177201039 |
| Mailing Telephone | 8175720009 |
| Mailing Fax Number | 8177201039 |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-07-06 |
| Authorized Official Name | TAMMIE MISKIMINS (MANAGER, PHARMACY LICENSING/CONTRAC) |
| Authorized Official Telephone | 8175720009 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | PH30219 | FL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2160919 | 01 |
| Other Name | Type Code |
|---|---|
| Synergy Specialty Pharmacy | Doing Business As Name - Organization |
| Street Address |
917 MAR WALT DR STE C |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6651 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043703952 | Shanna Balzamo | Pharmacist | 917 Mar Walt Dr Ste C, Fort Walton Beach, FL 32547-6651 | 2018-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326085093 | Albertsons LLC | Pharmacy | 610 Eglin Pkwy Ne, Fort Walton Beach, FL 32547-2832 | 2006-06-01 |
| 1811928930 | K Mart Corp | Pharmacy | 200 Irwin Ave Ne, Fort Walton Beach, FL 32548-4435 | 2006-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306452974 | Curry Ford Pharmacy LLC | Pharmacy | 4538 Curry Ford Rd, Orlando, FL 32812-2711 | 2020-09-19 |
| 1225641525 | Englewood Pharmaceutical Services Inc | Pharmacy | 1720 S Mccall Rd Ste J, Englewood, FL 34223-4867 | 2020-08-26 |
| 1972115103 | Intellrx Consulting LLC | Pharmacy | 1257 The 12th Fairway, Wellington, FL 33414-5738 | 2020-08-19 |
| 1518577576 | Publix Super Markets, Inc | Pharmacy | 7340 Kathleen Rd, Lakeland, FL 33810-4495 | 2020-08-05 |
| 1962011890 | Green Star Pharmacy | Pharmacy | 2950 Winkler Ave Ste 701, Fort Myers, FL 33916-9322 | 2020-07-27 |
| 1356959134 | Cverx Pharmacy Corp | Pharmacy | 7360 Sw 24th St Ste 29, Miami, FL 33155-1462 | 2020-07-17 |
| 1447877287 | Jerry Voltaire | Pharmacy | 16470 Cedar Run Dr, Orlando, FL 32828-6970 | 2020-06-27 |
| 1598381980 | John Melvin Schemm IIi | Pharmacy | 7617 Bay Port Rd, Orlando, FL 32819-5504 | 2020-06-22 |
| 1891318267 | Empire Specialty Pharmacy LLC | Pharmacy | 749 S Apollo Blvd, Melbourne, FL 32901-1457 | 2020-05-20 |
| 1992334205 | Mypills Pharmacy LLC | Pharmacy | 303a E 1st St, Sanford, FL 32771-1377 | 2020-04-07 |
| Find all providers with the same taxonomy | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
Please comment or provide details below to improve the information on EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.