Healthcare Provider Details

I. General information

NPI: 1396948865
Provider Name (Legal Business Name): JULIA ELIZABETH SUMMERS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 PAWNEE ST
CLINTON MO
64735-2757
US

IV. Provider business mailing address

57 NW 241ST RD
CLINTON MO
64735-8941
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-3034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2004031019
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: