MEDICARE: SUMMIT TRADING CO 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	CF00005161	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4924266	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1437152238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT TRADING CO INC

Provider Business Mailing Address
First Line	:	10409 CANYON RD E
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98373-4252
Country	:	US
Telephone Number	:	253-840-2098
Fax Number	:	253-840-0308

Provider Business Practice Location Address
First Line	:	10409 CANYON RD E
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98373-4252
Country	:	US
Telephone Number	:	253-840-2098
Fax Number	:	253-840-0308

Authorized Official
Title or Position	:	PIC
Name	:	JENNIFER CRUTCHER
Credential	:	RPH
Telephone Number	:	253-840-2098

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/04/2011

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Directions to “SUMMIT TRADING CO INC ” Practice Location

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