Provider Demographics
NPI:1336507565
Name:SYNERGY COMMUNITY PHARMACY LLC
Entity Type:Organization
Organization Name:SYNERGY COMMUNITY PHARMACY LLC
Other - Org Name:SYNERGY COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-412-3732
Mailing Address - Street 1:7820 IVANHOE AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4501
Mailing Address - Country:US
Mailing Address - Phone:858-412-3732
Mailing Address - Fax:858-412-3185
Practice Address - Street 1:7820 IVANHOE AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4501
Practice Address - Country:US
Practice Address - Phone:858-412-3732
Practice Address - Fax:858-412-3185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA541673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157989OtherPK