Provider Demographics
NPI:1558580241
Name:SUMMIT PHARMACY INC
Entity Type:Organization
Organization Name:SUMMIT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-904-3951
Mailing Address - Street 1:2320 WEST PEORIA AVE SUITE D132
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4768
Mailing Address - Country:US
Mailing Address - Phone:602-678-5400
Mailing Address - Fax:602-678-5401
Practice Address - Street 1:2320 WEST PEORIA AVE SUITE D132
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4768
Practice Address - Country:US
Practice Address - Phone:602-678-5400
Practice Address - Fax:602-678-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40763336C0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy