Provider Demographics
NPI:1518423946
Name:SUMMERS PHARMACY OF MARSHALL, LLC
Entity Type:Organization
Organization Name:SUMMERS PHARMACY OF MARSHALL, LLC
Other - Org Name:SUMMERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:660-885-3034
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 1:895 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-2912
Practice Address - Country:US
Practice Address - Phone:660-831-5220
Practice Address - Fax:660-530-4522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMERS PHARMACY OF WARRENSBURG, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-11
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600068258Medicaid