MEDICARE: SYNERGISTRX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

General Provider Information

NPI Number	:	1770226698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGISTRX INC

Provider Business Mailing Address
First Line	:	2803 GULF TO BAY BLVD # 255
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-4014
Country	:	US
Telephone Number	:	727-250-9038
Fax Number	:	727-379-8328

Provider Business Practice Location Address
First Line	:	2521 COLUMBUS WAY S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33712-3904
Country	:	US
Telephone Number	:	727-250-9038
Fax Number	:	727-379-8328

Authorized Official
Title or Position	:	CEO
Name	:	DR. ANNETTA ALLEN
Credential	:	PHARMD, MHA, BCPS
Telephone Number	:	727-250-9038

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	06/20/2022

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