96TH MEDICAL SUPPORT SQUADRON (NPI# 1598177123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598177123 |
| Entity Type | Organization |
| Organization Name | 96TH MEDICAL SUPPORT SQUADRON |
| Other Organization Name | DOD EGLIN EPHCY |
| Practice Address |
96 Medical Group Satellite Phcy Memorial Trail Bldg. 1758 Eglin Afb FL 32542 |
| Mailing Address |
96 Medical Support Squadron 307 Boatner Rd. Ste 114 Eglin Afb FL 32542-1302 |
| Practice Telephone | 8508838000 |
| Practice Fax Number | 8508839131 |
| Mailing Telephone | 8508838000 |
| Mailing Fax Number | 8508839322 |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2016-04-05 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2146012 | 01 |
| Other Name | Type Code |
|---|---|
| DoD EGLIN ePhcy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134518798 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 3120 A. Talon Way, Eglin Afb Fld #3, FL 32542 | 2015-01-20 |
| 1083012223 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 4315 El Salvador Way, Building 4315, Eglin Afb, FL 32542-1711 | 2014-12-19 |
| 1972602613 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 307 Boatner Rd Ste 114, Bldg 1405, Eglin Afb, FL 32542-1302 | 2006-09-21 |
| 1013016773 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 307 Boatner Rd Ste 114, Bldg 1758, Eglin Afb, FL 32542-1302 | 2006-09-21 |
| 1922107689 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 307 Boatner Rd Ste 114, Bldg 1758, Eglin Afb, FL 32542-1302 | 2006-09-21 |
| 1659478402 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2006-09-20 |
| Street Address |
96 MEDICAL GROUP SATELLITE PHCY MEMORIAL TRAIL BLDG. 1758 |
| City | EGLIN AFB |
| State | FL |
| Zip Code | 32542 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417440306 | Colt Sicher | Student in an Organized Health Care Education/Training Program | 96th Dental Squadron (afmc), Eglin Afb, Fl 32542, Apo, AA 32542 | 2018-06-14 |
| 1841679529 | Matthew Scurria | Dentist | 340 Boatner Rd. Bldg 2751, 96 Dental Squadron/sgdr, Eglin Afb, FL 32542 | 2015-05-27 |
| 1134518798 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 3120 A. Talon Way, Eglin Afb Fld #3, FL 32542 | 2015-01-20 |
| 1548602923 | Gerald Jordan Novack | Psychologist | 96mdos/sgow, 307 Boatner Rd, Fpo, AP 32542 | 2013-07-25 |
| 1699112821 | Taylor Anne Hahn | Obstetrics & Gynecology | 96th Medical Group, 307 Boatner Road, Eglin Air Force Base, FL 32542 | 2013-05-29 |
| 1730456948 | Nicholas Brandon Sager | Dentist | 340 Boatner Rd, Eglin Afb, Apo, AA 32542 | 2011-11-17 |
| 1134402662 | Jessamy Jae Thornton | Student in an Organized Health Care Education/Training Program | 340 Boatner Rd, Bldg 2751, Eglin Afb, FL 32542 | 2011-09-21 |
| 1346523974 | Mary Elizabeth Sorrentino | Dentist | 340 Boatner Road, Blgd. 2751, Eglin Afb, FL 32542 | 2011-09-20 |
| 1588945612 | Martin Army Community Hospital | Clinic/Center | 4327 North El Salvador Way, Eglin Afb, FL 32542 | 2011-09-02 |
| 1144516287 | Russell David Bienias | Dentist | 96th Dental Squadron (afmc), Eglin Afb, FL 32542 | 2011-06-28 |
| Find all providers in zip 32542 | ||||
| Taxonomy Code | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083012223 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 4315 El Salvador Way, Building 4315, Eglin Afb, FL 32542-1711 | 2014-12-19 |
| 1972602613 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 307 Boatner Rd Ste 114, Bldg 1405, Eglin Afb, FL 32542-1302 | 2006-09-21 |
| 1013016773 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 307 Boatner Rd Ste 114, Bldg 1758, Eglin Afb, FL 32542-1302 | 2006-09-21 |
| 1922107689 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 307 Boatner Rd Ste 114, Bldg 1758, Eglin Afb, FL 32542-1302 | 2006-09-21 |
| 1659478402 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 307 Boatner Rd Ste 114, Eglin Afb, FL 32542-1302 | 2006-09-20 |
| 1588647770 | 96th Medical Group | Military/U.S. Coast Guard Pharmacy | 307 Boatner Rd, Suite 114, Eglin Afb, FL 32542-1302 | 2005-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114425113 | Naval Hospital Pensacola | Military/U.S. Coast Guard Pharmacy | 2500 Veterans Way, Bldg 645, Panama City, FL 32408 | 2018-01-25 |
| 1134518798 | 96th Medical Support Squadron | Military/U.S. Coast Guard Pharmacy | 3120 A. Talon Way, Eglin Afb Fld #3, FL 32542 | 2015-01-20 |
| 1457764078 | Naval Hospital Pensacola | Military/U.S. Coast Guard Pharmacy | 5820 W Highway 98, Pensacola, FL 32507-1072 | 2014-06-11 |
| 1437562626 | Naval Hospital Pensacola | Military/U.S. Coast Guard Pharmacy | 7119 Langley St Bldg 2985, Milton, FL 32570-6105 | 2014-06-05 |
| 1932512498 | Mayport Refill Pharmacy | Military/U.S. Coast Guard Pharmacy | Naval Health Clinic Mayport, 2104 Massey Ave, Mayport, FL 32228 | 2014-06-03 |
| 1770995300 | Jacksonville Refill Pharmacy | Military/U.S. Coast Guard Pharmacy | Navy Exchange Pharmacy, Bldg 950, Jacksonville, FL 32214-5000 | 2014-06-02 |
| 1518301696 | Naval Hospital Pensacola | Military/U.S. Coast Guard Pharmacy | 5820 West Highway 98, Bldg 3737, Pensacola, FL 32507 | 2013-04-19 |
| 1356653844 | Us Coast Guard Finance Center | Military/U.S. Coast Guard Pharmacy | 100 Trumbo Point Road, Key West, FL 33040 | 2010-07-13 |
| 1518051093 | Hrs Citrus County Health Dept. Pharmacy | Military/U.S. Coast Guard Pharmacy | 2804 Marc Knighton Ct, Lecanto, FL 34461 | 2006-10-02 |
| 1831298595 | Mayport Pharmacy | Military/U.S. Coast Guard Pharmacy | Bldg 1363, Naval Air Station, Mayport, FL 32228-0148 | 2006-09-21 |
| Find all providers with the same taxonomy | ||||
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| 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.