Provider Demographics
NPI:1417599440
Name:518 SUMMIT CARE PHARMACY LLC
Entity Type:Organization
Organization Name:518 SUMMIT CARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-222-2721
Mailing Address - Street 1:518 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2915
Mailing Address - Country:US
Mailing Address - Phone:201-222-2721
Mailing Address - Fax:
Practice Address - Street 1:518 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2915
Practice Address - Country:US
Practice Address - Phone:201-222-2721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy