=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104097674
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT INVESTMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2008
-----------------------------------------------------
Last Update Date | 03/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1051 W.BUSCH BLVD. UNIT 1063
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-931-5010
-----------------------------------------------------
Fax | 813-931-0310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1051 W.BUSCH BLVD. UNIT 1063
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-931-5010
-----------------------------------------------------
Fax | 813-931-0310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. WALE JULIUS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-988-2300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH23231
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------