Healthcare Provider Details

I. General information

NPI: 1609186899
Provider Name (Legal Business Name): PRIME SYNERGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7333 LAKE UNDERHILL RD
ORLANDO FL
32822-6061
US

IV. Provider business mailing address

7333 LAKE UNDERHILL RD
ORLANDO FL
32822-6061
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-6626
  • Fax: 407-704-6627
Mailing address:
  • Phone: 407-704-6626
  • Fax: 407-704-6627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH25086
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAMESH PATHAK
Title or Position: PHARMACY MANAGER
Credential:
Phone: 407-704-6626