MEDICARE: CARRIE SUMMERTON RPH

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	183500000X	Pharmacist	26018976A	IN

General Provider Information

NPI Number	:	1457573891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE SUMMERTON RPH

Provider Business Mailing Address
First Line	:	710 W MAIN ST
Second Line	:
City	:	GREENTOWN
State	:	IN
Zip	:	46936-1045
Country	:	US
Telephone Number	:	765-628-3446
Fax Number	:	765-453-1290

Provider Business Practice Location Address
First Line	:	710 W MAIN ST
Second Line	:
City	:	GREENTOWN
State	:	IN
Zip	:	46936-1045
Country	:	US
Telephone Number	:	765-628-3446
Fax Number	:	765-453-1290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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Directions to “ CARRIE SUMMERTON RPH” Practice Location

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