Provider Demographics
NPI:1649384595
Name:APS-SUMMIT CARE PHARMACY, LLC
Entity Type:Organization
Organization Name:APS-SUMMIT CARE PHARMACY, LLC
Other - Org Name:OMNICARE OF AUSTIN #48350
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR, PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-2751
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:BOX 1075
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9210 CAMERON RD
Practice Address - Street 2:SUITE 800
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-3918
Practice Address - Country:US
Practice Address - Phone:512-928-8282
Practice Address - Fax:512-928-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350091Medicaid
4591637OtherNCPDP
TX350091Medicaid