Healthcare Provider Details

I. General information

NPI: 1861904153
Provider Name (Legal Business Name): EMILY SUMMERS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 W OVERLAND RD
BOISE ID
83705-2633
US

IV. Provider business mailing address

4173 N BEAHAM PL
MERIDIAN ID
83646-3730
US

V. Phone/Fax

Practice location:
  • Phone: 208-389-1448
  • Fax:
Mailing address:
  • Phone: 406-239-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP7871
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: