MEDICARE: SUMMERTON DRUGS INC

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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	8933	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2088633	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891770574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMERTON DRUGS INC

Provider Business Mailing Address
First Line	:	PO BOX 37
Second Line	:
City	:	SUMMERTON
State	:	SC
Zip	:	29148-0037
Country	:	US
Telephone Number	:	803-485-8725
Fax Number	:	803-485-4306

Provider Business Practice Location Address
First Line	:	115 E MAIN ST
Second Line	:
City	:	SUMMERTON
State	:	SC
Zip	:	29148-6904
Country	:	US
Telephone Number	:	803-485-8725
Fax Number	:	803-485-4306

Authorized Official
Title or Position	:	OWNER,AO
Name	:	EUGENE PHILLIPS
Credential	:
Telephone Number	:	803-485-8725

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	04/14/2015

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