Provider Demographics
NPI:1265537138
Name:SUMMERS, JOHN MARCUS (PD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARCUS
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-2216
Mailing Address - Country:US
Mailing Address - Phone:870-352-2161
Mailing Address - Fax:870-352-3236
Practice Address - Street 1:908 W 4TH ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-2216
Practice Address - Country:US
Practice Address - Phone:870-352-2161
Practice Address - Fax:870-352-3236
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist