Healthcare Provider Details

I. General information

NPI: 1710084561
Provider Name (Legal Business Name): NAVAL HOSPITAL PENSACOLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 DAUPHINE ST BLDG 601
NEW ORLEANS LA
70146-5609
US

IV. Provider business mailing address

NAVAL HOSPITAL PENSACOLA 6000 W HWY 98 CODE 41C
PENSACOLA FL
32512-0001
US

V. Phone/Fax

Practice location:
  • Phone: 504-678-1590
  • Fax: 504-678-1596
Mailing address:
  • Phone: 504-678-1590
  • Fax: 504-678-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM MICHAEL CONDON
Title or Position: NAVY MEDICINE UBO PROGRAM MANAGER
Credential:
Phone: 240-401-3643