Synergen RX LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SYNERGEN RX LLC

Practice address

3990 Flowers Rd Ste 530
Doraville, GA 30360-3195

Phone

(404) 585-7517

Fax

(404) 900-9209

NPI assigned

Apr 18, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonathan Personius

Title

Owner

Phone

(478) 951-6066

Specialties & licenses 3

Addresses

Other names 1

• Synergen Rx Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Synergen RX LLC

  • Community/Retail Pharmacy
  • Atlanta, GA
  • NPI 1346817905

  6204166853

  Same PAC ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Walter Won Shutter

  • Pharmacist
  • Atlanta, GA
  • NPI 1285246462
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623974400000",
    "number": "1811550528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3990 FLOWERS RD STE 530",
            "city": "DORAVILLE",
            "state": "GA",
            "postal_code": "303603195",
            "telephone_number": "404-585-7517",
            "fax_number": "404-900-9209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 FLOWERS RD STE 530",
            "city": "DORAVILLE",
            "state": "GA",
            "postal_code": "303603195",
            "telephone_number": "404-585-7517",
            "fax_number": "404-900-9209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGEN RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-18",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A",
        "authorized_official_last_name": "PERSONIUS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-951-6066"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Synergen Rx",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Synergen Rx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tracy Smith, MS, CCC-SLP
• Yesenia Sosa
• Virginia Stelling
• Evan Robert Strahl, DC
• Sung Yang DC, PC
• Synergen RX, LLC
• Synergen RX, LLC
• T.J. Vision
• Tarra L Ray Malpc, LLC.
• Telerad of Georgia Account Management

• Community/Retail Pharmacy in Doraville, GA
• Providers in Doraville, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.