Healthcare Provider Details

I. General information

NPI: 1649720483
Provider Name (Legal Business Name): SUMMIT PHARMACY & SURGICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 SUMMIT AVE
GREENSBORO NC
27405-7918
US

IV. Provider business mailing address

930 SUMMIT AVE
GREENSBORO NC
27405-7918
US

V. Phone/Fax

Practice location:
  • Phone: 336-455-1263
  • Fax:
Mailing address:
  • Phone: 336-455-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number13078
License Number StateNC

VIII. Authorized Official

Name: VISHAL PATEL
Title or Position: PIC
Credential:
Phone: 336-763-7282