Healthcare Provider Details

I. General information

NPI: 1225622152
Provider Name (Legal Business Name): SUMMERS PHARMACY 12 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 S 7 HWY
BLUE SPRINGS MO
64014-4565
US

IV. Provider business mailing address

605 PAWNEE ST
CLINTON MO
64735-2757
US

V. Phone/Fax

Practice location:
  • Phone: 816-339-9880
  • Fax: 816-339-9881
Mailing address:
  • Phone: 660-383-1910
  • Fax: 660-885-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: RYAN SUMMERS
Title or Position: OWNER
Credential:
Phone: 816-339-9880