Healthcare Provider Details

I. General information

NPI: 1053953109
Provider Name (Legal Business Name): SUMMERS PHARMACY OF SLATER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E MAPLE ST
SLATER MO
65349-1539
US

IV. Provider business mailing address

605 PAWNEE ST
CLINTON MO
64735-2757
US

V. Phone/Fax

Practice location:
  • Phone: 660-529-9908
  • Fax: 660-529-9918
Mailing address:
  • Phone: 660-383-1910
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RYAN K SUMMERS
Title or Position: PRESIDENT
Credential: PHARM D
Phone: 660-885-3034