MEDICARE: MELANIE FAWCETT SUMMERELL 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	0202006806	VA
2	183500000X	Pharmacist	RPH011391	GA

General Provider Information

NPI Number	:	1518250935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE FAWCETT SUMMERELL RPH

Provider Business Mailing Address
First Line	:	42015 VILLAGE CENTER PLZ
Second Line	:
City	:	STONE RIDGE
State	:	VA
Zip	:	20105-3033
Country	:	US
Telephone Number	:	703-542-8344
Fax Number	:	703-542-8351

Provider Business Practice Location Address
First Line	:	42015 VILLAGE CENTER PLZ
Second Line	:
City	:	STONE RIDGE
State	:	VA
Zip	:	20105-3033
Country	:	US
Telephone Number	:	703-542-8344
Fax Number	:	703-542-8351

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

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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