Healthcare Provider Details

I. General information

NPI: 1073852984
Provider Name (Legal Business Name): SYNERGY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101E G T THAMES DR
STARKVILLE MS
39759-9042
US

IV. Provider business mailing address

101E G T THAMES DR
STARKVILLE MS
39759-9042
US

V. Phone/Fax

Practice location:
  • Phone: 662-268-8226
  • Fax: 662-268-8288
Mailing address:
  • Phone: 662-268-8226
  • Fax: 662-268-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberF12102
License Number StateMS

VIII. Authorized Official

Name: ALLAN SMITH
Title or Position: MANAGER/MEMBER
Credential:
Phone: 662-268-8226