Healthcare Provider Details

I. General information

NPI: 1477582625
Provider Name (Legal Business Name): SUMMERS PHARMACY OF APPLETON CITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W 4TH ST
APPLETON CITY MO
64724
US

IV. Provider business mailing address

605 PAWNEE STREET
CLINTON MO
64735
US

V. Phone/Fax

Practice location:
  • Phone: 660-476-2142
  • Fax: 660-476-5563
Mailing address:
  • Phone: 660-383-1910
  • Fax: 660-885-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5541
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JULIA SUMMERS
Title or Position: PRESIDENT
Credential:
Phone: 660-383-1910