Provider Demographics
NPI:1720076037
Name:SUMMERS, RYAN KENT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KENT
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 NW 241ST RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8941
Mailing Address - Country:US
Mailing Address - Phone:660-351-0602
Mailing Address - Fax:
Practice Address - Street 1:605 PAWNEE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2757
Practice Address - Country:US
Practice Address - Phone:660-885-3034
Practice Address - Fax:660-885-5888
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005017351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist