Provider Demographics
NPI:1578237426
Name:SYNERGEN RX, LLC
Entity Type:Organization
Organization Name:SYNERGEN RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSONIUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
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 1:3990 FLOWERS RD STE 530
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30360-3195
Practice Address - Country:US
Practice Address - Phone:404-585-7517
Practice Address - Fax:404-900-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy