Provider Demographics
NPI:1073852984
Name:SYNERGY PHARMACY LLC
Entity Type:Organization
Organization Name:SYNERGY PHARMACY LLC
Other - Org Name:SYNERGY PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-268-8226
Mailing Address - Street 1:101E G T THAMES DR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9042
Mailing Address - Country:US
Mailing Address - Phone:662-268-8226
Mailing Address - Fax:662-268-8288
Practice Address - Street 1:101E G T THAMES DR
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9042
Practice Address - Country:US
Practice Address - Phone:662-268-8226
Practice Address - Fax:662-268-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
MSF121023336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138942OtherPK