Provider Demographics
NPI:1760463079
Name:SUMMERFORD DRUGS, INC.
Entity Type:Organization
Organization Name:SUMMERFORD DRUGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SUMMERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-784-5275
Mailing Address - Street 1:4087 HIGHWAY 31 SW
Mailing Address - Street 2:
Mailing Address - City:FALKVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35622-6319
Mailing Address - Country:US
Mailing Address - Phone:256-784-5275
Mailing Address - Fax:256-784-5852
Practice Address - Street 1:4087 HIGHWAY 31 SW
Practice Address - Street 2:
Practice Address - City:FALKVILLE
Practice Address - State:AL
Practice Address - Zip Code:35622-6319
Practice Address - Country:US
Practice Address - Phone:256-784-5275
Practice Address - Fax:256-784-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL139865332BP3500X
AL1801683336I0012X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002479Medicaid