=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952313793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM J SUMMERS RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 666 COURTLANDT AVE MELROSE PHARMACY
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10451-5018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-292-1856
-----------------------------------------------------
Fax | 718-665-2123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3840 ORLOFF AVE APT 3A
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10463-2614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-884-5778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 036253
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------