Provider Demographics
NPI:1598142895
Name:SYNERGY LABORATORIES, INC.
Entity Type:Organization
Organization Name:SYNERGY LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADRICK
Authorized Official - Middle Name:O
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-662-9760
Mailing Address - Street 1:5570 RANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-9540
Mailing Address - Country:US
Mailing Address - Phone:251-662-9760
Mailing Address - Fax:251-272-1979
Practice Address - Street 1:5570 RANGELINE RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9540
Practice Address - Country:US
Practice Address - Phone:251-662-9760
Practice Address - Fax:251-272-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL01D2093765291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory