MEDICARE: SUMMIT PARK PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	027337	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3349443	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063427656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT PARK PHARMACY INC

Provider Business Mailing Address
First Line	:	2578 NIAGARA FALLS BLVD
Second Line	:	SUITE 100
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-4681
Country	:	US
Telephone Number	:	716-297-7151
Fax Number	:	716-297-7110

Provider Business Practice Location Address
First Line	:	2578 NIAGARA FALLS BLVD
Second Line	:	SUITE 100
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-4681
Country	:	US
Telephone Number	:	716-297-7151
Fax Number	:	716-297-7110

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	CHRISTOPHER SAULS
Credential	:	RPH
Telephone Number	:	716-731-3500

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	05/15/2023

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Directions to “SUMMIT PARK PHARMACY INC ” Practice Location

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