Provider Demographics
NPI:1972139723
Name:SUMMERS PHARMACY
Entity Type:Organization
Organization Name:SUMMERS PHARMACY
Other - Org Name:SUMMERS PHARMACY OF BUTLER - LONG-TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPERRY
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:
Practice Address - Street 1:913 W FORT SCOTT ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1204
Practice Address - Country:US
Practice Address - Phone:660-679-5002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMERS PHARMACY ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-12
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO300022539Medicaid