Provider Demographics
NPI:1346817905
Name:SYNERGEN RX LLC
Entity Type:Organization
Organization Name:SYNERGEN RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:TOKASH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:404-585-7517
Mailing Address - Street 1:3990 FLOWERS RD STE 530
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30360-3195
Mailing Address - Country:US
Mailing Address - Phone:404-585-7517
Mailing Address - Fax:404-900-9209
Practice Address - Street 1:1447 PEACHTREE ST NE STE 206
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3018
Practice Address - Country:US
Practice Address - Phone:770-727-0443
Practice Address - Fax:404-900-9209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYNERGEN RX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE10942OtherGEORGIA BOARD OF PHARMACY