Provider Demographics
NPI:1114928173
Name:SUMMERS, VICKIE C (DPH)
Entity Type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:C
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12935 PARIS ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-2738
Mailing Address - Country:US
Mailing Address - Phone:731-225-6714
Mailing Address - Fax:731-847-3788
Practice Address - Street 1:179 TENNESSEE AVE N
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-2002
Practice Address - Country:US
Practice Address - Phone:731-847-3784
Practice Address - Fax:731-847-3788
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist