Provider Demographics
NPI:1356326045
Name:SUMMA PHARMACY
Entity Type:Organization
Organization Name:SUMMA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SUMMA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:660-736-4621
Mailing Address - Street 1:509 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TARKIO
Mailing Address - State:MO
Mailing Address - Zip Code:64491-1546
Mailing Address - Country:US
Mailing Address - Phone:660-736-4621
Mailing Address - Fax:660-736-5342
Practice Address - Street 1:509 MAIN ST
Practice Address - Street 2:
Practice Address - City:TARKIO
Practice Address - State:MO
Practice Address - Zip Code:64491-1546
Practice Address - Country:US
Practice Address - Phone:660-736-4621
Practice Address - Fax:660-736-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty