Provider Demographics
NPI:1912720814
Name:SYNERGY APOTHECARY LLC
Entity type:Organization
Organization Name:SYNERGY APOTHECARY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:414-721-6816
Mailing Address - Street 1:10101 W INNOVATION DR STE 600
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4824
Mailing Address - Country:US
Mailing Address - Phone:414-721-6816
Mailing Address - Fax:800-917-2591
Practice Address - Street 1:10101 W INNOVATION DR STE 600
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4824
Practice Address - Country:US
Practice Address - Phone:414-721-6816
Practice Address - Fax:800-917-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy