Healthcare Provider Details

I. General information

NPI: 1437201613
Provider Name (Legal Business Name): SUMMERFIELD PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13057 SUMMERFIELD SQUARE DR
RIVERVIEW FL
33578-7402
US

IV. Provider business mailing address

13057 SUMMERFIELD SQUARE DR
RIVERVIEW FL
33578-7402
US

V. Phone/Fax

Practice location:
  • Phone: 813-234-9409
  • Fax: 813-234-9416
Mailing address:
  • Phone: 813-234-9409
  • Fax: 813-234-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH21074
License Number StateFL

VIII. Authorized Official

Name: MS. KAREN M SMALL
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 813-234-9409