Provider Demographics
NPI:1912348350
Name:SYNERGY RX LLC
Entity Type:Organization
Organization Name:SYNERGY RX LLC
Other - Org Name:SYNERGY RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-792-6676
Mailing Address - Street 1:4901 MORENA BLVD
Mailing Address - Street 2:#504-A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3423
Mailing Address - Country:US
Mailing Address - Phone:855-792-6676
Mailing Address - Fax:858-246-6724
Practice Address - Street 1:4901 MORENA BLVD
Practice Address - Street 2:#504-A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3423
Practice Address - Country:US
Practice Address - Phone:855-792-6676
Practice Address - Fax:858-246-6724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515363336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy