Provider Demographics
NPI:1891770574
Name:SUMMERTON DRUGS INC
Entity Type:Organization
Organization Name:SUMMERTON DRUGS INC
Other - Org Name:SUMMERTON DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,AO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-485-8725
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:SUMMERTON
Mailing Address - State:SC
Mailing Address - Zip Code:29148-0037
Mailing Address - Country:US
Mailing Address - Phone:803-485-8725
Mailing Address - Fax:803-485-4306
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERTON
Practice Address - State:SC
Practice Address - Zip Code:29148-6904
Practice Address - Country:US
Practice Address - Phone:803-485-8725
Practice Address - Fax:803-485-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
SC89333336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2088633OtherPK
SC719399Medicaid
SC719399Medicaid