Provider Demographics
NPI:1417614702
Name:SUMMERS PHARMACY 13 INC
Entity type:Organization
Organization Name:SUMMERS PHARMACY 13 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:660-351-0602
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:660-851-0717
Mailing Address - Fax:660-310-3170
Practice Address - Street 1:1020 THOMPSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2243
Practice Address - Country:US
Practice Address - Phone:660-851-0717
Practice Address - Fax:660-310-3170
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMERS PHARMACY ENTERPRISES, CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-21
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600105307Medicaid