Provider Demographics
NPI:1497874937
Name:SUMMERS PHARMACY OF APPLETON CITY, INC
Entity Type:Organization
Organization Name:SUMMERS PHARMACY OF APPLETON CITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-383-1910
Mailing Address - Street 1:605 PAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-2757
Mailing Address - Country:US
Mailing Address - Phone:660-383-1910
Mailing Address - Fax:660-885-5888
Practice Address - Street 1:121 W 4TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1401
Practice Address - Country:US
Practice Address - Phone:660-476-2142
Practice Address - Fax:660-476-5563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMERS PHARMACY ENTERPRISES, CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPS005541332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO622280709Medicaid