Healthcare Provider Details

I. General information

NPI: 1306189154
Provider Name (Legal Business Name): SUMMITT MTM PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2013
Last Update Date: 03/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1978 OAK GROVE RD
DANDRIDGE TN
37725-5029
US

IV. Provider business mailing address

PO BOX 1728 1978 OAK GROVE ROAD
DANDRIDGE TN
37725-1728
US

V. Phone/Fax

Practice location:
  • Phone: 865-680-5221
  • Fax: 865-381-2110
Mailing address:
  • Phone: 865-748-7417
  • Fax: 865-381-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5151
License Number StateTN

VIII. Authorized Official

Name: ELIZABETH LOVELACE SUMMITT
Title or Position: OWNER/PHARMACIST
Credential: PHARM.D.
Phone: 865-748-7417