Provider Demographics
NPI:1497740435
Name:SUMMIT HEALTH PHARMACY, LLC
Entity Type:Organization
Organization Name:SUMMIT HEALTH PHARMACY, LLC
Other - Org Name:BURMANS COMMUNITY PHARMACY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP/SECRETARY/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-808-9838
Mailing Address - Street 1:3400 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015
Mailing Address - Country:US
Mailing Address - Phone:610-872-5418
Mailing Address - Fax:610-872-1969
Practice Address - Street 1:3400 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015
Practice Address - Country:US
Practice Address - Phone:610-872-5418
Practice Address - Fax:610-872-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412241L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015234190002Medicaid
PAPP412241LOtherCOMMONWEALTH OF PA
PAPP412241LOtherCOMMONWEALTH OF PA
BB4487713OtherDEA