Healthcare Provider Details

I. General information

NPI: 1891770574
Provider Name (Legal Business Name): SUMMERTON DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E MAIN ST
SUMMERTON SC
29148-6904
US

IV. Provider business mailing address

PO BOX 37
SUMMERTON SC
29148-0037
US

V. Phone/Fax

Practice location:
  • Phone: 803-485-8725
  • Fax: 803-485-4306
Mailing address:
  • Phone: 803-485-8725
  • Fax: 803-485-4306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8933
License Number StateSC

VIII. Authorized Official

Name: EUGENE PHILLIPS
Title or Position: OWNER,AO
Credential:
Phone: 803-485-8725