Healthcare Provider Details

I. General information

NPI: 1497874937
Provider Name (Legal Business Name): SUMMERS PHARMACY OF APPLETON CITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W 4TH ST
APPLETON CITY MO
64724-1401
US

IV. Provider business mailing address

605 PAWNEE ST
CLINTON MO
64735-2757
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPS005541
License Number StateMO

VIII. Authorized Official

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