MEDICARE: SYNERGY RX LLC

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	3336C0004X	Compounding Pharmacy	51536	CA

General Provider Information

NPI Number	:	1912348350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY RX LLC

Provider Business Mailing Address
First Line	:	4901 MORENA BLVD
Second Line	:	#504-A
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3423
Country	:	US
Telephone Number	:	855-792-6676
Fax Number	:	858-246-6724

Provider Business Practice Location Address
First Line	:	4901 MORENA BLVD
Second Line	:	#504-A
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3423
Country	:	US
Telephone Number	:	855-792-6676
Fax Number	:	858-246-6724

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MRS. COURTNEY FORSTER
Credential	:
Telephone Number	:	855-792-6676

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	07/15/2013

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Directions to “SYNERGY RX LLC ” Practice Location

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