Organization
EMERALD COAST INFECTIOUS DISEASES MEDICAL GROUP, PA
Active
Parent organization
EMERALD COAST INFECTIOUS DISEASES
Other names
Synergy Specialty Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
EMERALD COAST INFECTIOUS DISEASES
Authorized official
MR. ERIC SQUATRITO (VICE PRESIDENT OF OPERATIONS)
(724) 977-8498
Entity
Organization
Contact information
Practice address
917 MAR WALT DRIVE, SUITE D, FORT WALTON BEACH, FL 32547
(850) 312-3570
(850) 312-3090
Mailing address
1620 W. NORTHWEST HWY, SUITE 100, GRAPEVINE, TX 76051
(817) 572-0009
(817) 572-0221
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PH30219
FL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1165528300
—
FL
01
—
2160919
PK
—
Enumeration date
07/06/2016
Last updated
03/03/2025
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