Organization
TEXAS STATE PHARMACY LLC
Active
Other names
Synergy Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KEERTHI KOTA (PRESIDENT)
(210) 704-1551
Entity
Organization
Contact information
Practice address
1314 E SONTERRA BLVD STE 2102, SAN ANTONIO, TX 78258-4286
(210) 704-1551
(210) 907-7551
Mailing address
430 S HIGHWAY 78 STE 160, WYLIE, TX 75098-3974
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5929952
STATE BOARD LICENSE
TX
Enumeration date
11/26/2019
Last updated
03/27/2020
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