Healthcare Provider Details

I. General information

NPI: 1720076037
Provider Name (Legal Business Name): RYAN KENT SUMMERS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
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: 660-885-5888
Mailing address:
  • Phone: 660-351-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2005017351
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: