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1346817905 NPI number — SYNERGEN RX LLC

NPI Number: 1346817905
Health Care Provider/Practitioner: SYNERGEN RX LLC

Information about “1346817905” NPI (SYNERGEN RX LLC) exists in 1346817905 in HTML format HTML  |  1346817905 in plain Text format TXT  |  1346817905 in PDF (Portable Document Format) PDF  |  1346817905 in an XML format XML  formats.

NPI Number : 1346817905 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346817905",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "SYNERGEN RX, LLC",
    "ParentOrgTIN": null,
    "OrgName": "SYNERGEN RX LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3990 FLOWERS RD STE 530",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DORAVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30360-3195",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "404-585-7517",
    "MailingAddressFaxNumber": "404-900-9209",
    "FirstLinePracticeLocationAddress": "1447 PEACHTREE ST NE STE 206",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ATLANTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30309-3018",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-727-0443",
    "PracticeLocationAddressFaxNumber": "404-900-9209",
    "EnumerationDate": "06/10/2021",
    "LastUpdateDate": "06/10/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TOKASH",
    "AuthorizedOfficialFirstName": "IAN",
    "AuthorizedOfficialMiddleName": "CORY",
    "AuthorizedOfficialTitle": "VP OPERATIONS",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MBA",
    "AuthorizedOfficialTelephoneNumber": "404-585-7517",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3336C0003X",
        "TaxonomyName": "Community/Retail Pharmacy",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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