Healthcare Provider Details

I. General information

NPI: 1255235552
Provider Name (Legal Business Name): SUMMERS PHARMACY NO 9, LLC DBA SUMMERS PHARMACY OF COLE CAMP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 W MAIN ST
COLE CAMP MO
65325-1018
US

IV. Provider business mailing address

605 PAWNEE ST
CLINTON MO
64735-2757
US

V. Phone/Fax

Practice location:
  • Phone: 660-668-4646
  • Fax: 660-668-4633
Mailing address:
  • Phone: 660-383-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

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