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General NPI Number Information
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NPI Number | 1811550528
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Entity Type | Organization
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Legal Business Name | SYNERGEN RX LLC
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Dates
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Enumeration Date | 04/18/2019
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 3990 FLOWERS RD STE 530
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City | DORAVILLE
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State | GA
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Zip | 30360-3195
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Country | US
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Telephone | 404-585-7517
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Fax | 404-900-9209
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Provider Business Mailing Address
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Address Line | 3990 FLOWERS RD STE 530
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City | DORAVILLE
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State | GA
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Zip | 30360-3195
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Country | US
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Telephone | 404-585-7517
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Fax | 404-900-9209
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN PERSONIUS
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Credential |
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Telephone | 478-951-6066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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