Healthcare Provider Details

I. General information

NPI: 1720586332
Provider Name (Legal Business Name): SUMMIT EXPRESS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 08/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S LAUREL ST
SUMMIT MS
39666
US

IV. Provider business mailing address

PO BOX 1310
SUMMIT MS
39666-1301
US

V. Phone/Fax

Practice location:
  • Phone: 601-465-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARTY BIGNER
Title or Position: PHARMACIST
Credential:
Phone: 601-465-0500