=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477435949
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAILEY SUMMERS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 W STATE ST
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49058-1875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-945-2466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 59260 DEXTROM RD
-----------------------------------------------------
City | CALUMET
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49913-8842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-369-3402
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302417713
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------