Healthcare Provider Details

I. General information

NPI: 1104611144
Provider Name (Legal Business Name): SUMMIT PHARMACY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 LAKE TAHOE BLVD STE 1
SOUTH LAKE TAHOE CA
96150-6408
US

IV. Provider business mailing address

2074 LAKE TAHOE BLVD STE 1
SOUTH LAKE TAHOE CA
96150-6408
US

V. Phone/Fax

Practice location:
  • Phone: 530-541-0870
  • Fax: 530-541-0884
Mailing address:
  • Phone: 530-541-0870
  • Fax: 530-541-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN MCMILLEN-MITCHELL
Title or Position: CEO - KM HEALTH SOLUTIONS, INC.
Credential:
Phone: 530-541-0870