Healthcare Provider Details

I. General information

NPI: 1518423946
Provider Name (Legal Business Name): SUMMERS PHARMACY OF MARSHALL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 W COLLEGE ST
MARSHALL MO
65340-2912
US

IV. Provider business mailing address

605 PAWNEE ST
CLINTON MO
64735-2757
US

V. Phone/Fax

Practice location:
  • Phone: 660-831-5220
  • Fax: 660-530-4522
Mailing address:
  • Phone: 660-383-1910
  • Fax: 660-885-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RYAN KENT SUMMERS
Title or Position: MANAGING MEMBER
Credential: PHARM D
Phone: 660-885-3034