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General NPI Number Information
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NPI Number | 1912720814
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Entity Type | Organization
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Legal Business Name | SYNERGY APOTHECARY LLC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 10101 W INNOVATION DR STE 600
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City | WAUWATOSA
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State | WI
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Zip | 53226-4824
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Country | US
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Telephone | 414-721-6816
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Fax | 800-917-2591
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Provider Business Mailing Address
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Address Line | 10101 W INNOVATION DR STE 600
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City | WAUWATOSA
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State | WI
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Zip | 53226-4824
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Country | US
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Telephone | 414-721-6816
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Fax | 800-917-2591
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | THERESA BERGH
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Credential | RPH
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Telephone | 414-721-6816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order 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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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