MEDICARE: JOHN ROBERT SUMMEROUR 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	17889	NC

General Provider Information

NPI Number	:	1952691586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ROBERT SUMMEROUR RPH

Provider Business Mailing Address
First Line	:	62 SKYLINE DR
Second Line	:
City	:	OLD FORT
State	:	NC
Zip	:	28762-9677
Country	:	US
Telephone Number	:	828-652-4343
Fax Number	:	828-652-7715

Provider Business Practice Location Address
First Line	:	62 SKYLINE DR
Second Line	:
City	:	OLD FORT
State	:	NC
Zip	:	28762-9677
Country	:	US
Telephone Number	:	828-652-4343
Fax Number	:	828-652-7715

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

Provider Enumeration Date	:	04/16/2011
Last Update Date	:	04/16/2011

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