Provider Demographics
NPI:1174997118
Name:SUMMA HEALTH ROOTSTOWN PHARMACY
Entity type:Organization
Organization Name:SUMMA HEALTH ROOTSTOWN PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-221-5334
Mailing Address - Street 1:4211 STATE ROUTE 44 SUITE 1500
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272-9733
Mailing Address - Country:US
Mailing Address - Phone:330-325-0589
Mailing Address - Fax:330-325-0934
Practice Address - Street 1:4211 STATE ROUTE 44 STE 1500
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272-9733
Practice Address - Country:US
Practice Address - Phone:330-325-0589
Practice Address - Fax:303-250-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155317OtherPK