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NPI Code Detail

MEDICARE: SUMMERS PHARMACY OF NEVADA LLC

MEDICARE: SUMMERS PHARMACY OF NEVADA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy2016010547MO
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22159366OTHERPK

General Provider Information

NPI Number : 1013081090
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUMMERS PHARMACY OF NEVADA LLC
Provider Business Mailing Address
First Line : 605 PAWNEE ST
Second Line :
City : CLINTON
State : MO
Zip : 64735-2757
Country : US
Telephone Number : 417-667-6044
Fax Number : 417-667-0544
Provider Business Practice Location Address
First Line : 900 S ADAMS ST
Second Line :
City : NEVADA
State : MO
Zip : 64772-3210
Country : US
Telephone Number : 417-667-6044
Fax Number : 417-667-0544
Authorized Official
Title or Position : PRESIDENT
Name : RYAN SUMMERS
Credential :
Telephone Number : 660-885-3034
Provider Enumeration Date : 11/20/2006
Last Update Date : 07/10/2019

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Directions to “SUMMERS PHARMACY OF NEVADA LLC ” Practice Location

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