Provider Demographics
NPI:1568534352
Name:SUMMIT RX, LLC
Entity type:Organization
Organization Name:SUMMIT RX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARACCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-506-2587
Mailing Address - Street 1:1405 NE DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4609
Mailing Address - Country:US
Mailing Address - Phone:816-524-8444
Mailing Address - Fax:816-246-5493
Practice Address - Street 1:1405 NE DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4609
Practice Address - Country:US
Practice Address - Phone:816-524-8444
Practice Address - Fax:816-246-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003028359333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2621274OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MO602046406Medicaid
MO602046406Medicaid