The United States (US) pharmaceutical manufacturing industry comprises about 570 facilities in 39 states. About 20 percent of US pharmaceutical manufacturing facilities are categorized as chemical synthesis plants producing medicinal chemicals (fine chemicals). Some of synthesis plants also involve fermentation process. This discussion of wastewater treatment technologies from US synthesized chemicals manufacturing facilities is intended to provide China and other Pacific Rim countries with the benefit of US experience. It will also assist China and other Pacific Rim countries in developing treatment options and meeting regulatory effluent limitations.