Provider Demographics
NPI:1952691586
Name:SUMMEROUR, JOHN ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:SUMMEROUR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-9677
Mailing Address - Country:US
Mailing Address - Phone:828-652-4343
Mailing Address - Fax:828-652-7715
Practice Address - Street 1:62 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:NC
Practice Address - Zip Code:28762-9677
Practice Address - Country:US
Practice Address - Phone:828-652-4343
Practice Address - Fax:828-652-7715
Is Sole Proprietor?:No
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist