Healthcare Provider Details

I. General information

NPI: 1861185548
Provider Name (Legal Business Name): SUMMERTON DRUGS COMPOUNDING AND DISPENSARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115B 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 TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERNEST EUGENE PHILLIPS III
Title or Position: OWNER
Credential:
Phone: 803-485-8586