Provider Demographics
NPI:1992192868
Name:SUMMERS, SUSAN I
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SUMMERS
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9212 GOOSE POND DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-3334
Mailing Address - Country:US
Mailing Address - Phone:410-271-5422
Mailing Address - Fax:
Practice Address - Street 1:9212 GOOSE POND DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-3334
Practice Address - Country:US
Practice Address - Phone:410-271-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-18
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12176OtherPHARMACY LICENSE