Provider Demographics
NPI:1437152238
Name:SUMMIT TRADING CO INC
Entity Type:Organization
Organization Name:SUMMIT TRADING CO INC
Other - Org Name:SUMMIT TRADING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:253-840-2098
Mailing Address - Street 1:10409 CANYON RD E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4252
Mailing Address - Country:US
Mailing Address - Phone:253-840-2098
Mailing Address - Fax:253-840-0308
Practice Address - Street 1:10409 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4252
Practice Address - Country:US
Practice Address - Phone:253-840-2098
Practice Address - Fax:253-840-0308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WACF000051613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6015192Medicaid
4924266OtherNCPDP PROVIDER IDENTIFICATION NUMBER