Provider Demographics
NPI:1356497770
Name:SUMMIT PHARMACY GROUP LLC
Entity Type:Organization
Organization Name:SUMMIT PHARMACY GROUP LLC
Other - Org Name:HEALTH CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SREEDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VAJINEPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-333-6968
Mailing Address - Street 1:103 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-3021
Mailing Address - Country:US
Mailing Address - Phone:201-333-6968
Mailing Address - Fax:201-333-6883
Practice Address - Street 1:103 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3021
Practice Address - Country:US
Practice Address - Phone:201-333-6968
Practice Address - Fax:201-333-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006557003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159772OtherPK