Provider Demographics
NPI:1720384779
Name:SUMMIT PHARMACY SOLUTIONS LLC
Entity Type:Organization
Organization Name:SUMMIT PHARMACY SOLUTIONS LLC
Other - Org Name:SUMMIT PHARMACY SOLUTIONS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-1155
Mailing Address - Street 1:5111 MARYLAND WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7513
Mailing Address - Country:US
Mailing Address - Phone:615-221-1155
Mailing Address - Fax:615-221-1199
Practice Address - Street 1:5111 MARYLAND WAY STE 201
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7513
Practice Address - Country:US
Practice Address - Phone:615-221-1155
Practice Address - Fax:615-221-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4840333600000X
3336L0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4444092OtherNCPDP PROVIDER IDENTIFICATION NUMBER