NPIMap

Organization Active NPI

Summers Pharmacy of Marshall, LLC

Doing business as Summers Pharmacy

  • Community/Retail Pharmacy
  • Marshall, MO
National Provider Identifier
1518423946
Registry record updated Jan 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SUMMERS PHARMACY OF MARSHALL, LLC
Doing business as
Summers Pharmacy
Practice address
895 W College St
Marshall, MO 65340-2912
Phone
(660) 831-5220
Fax
(660) 530-4522
NPI assigned
Feb 11, 2019
Last updated
Jan 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SUMMERS PHARMACY OF WARRENSBURG, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ryan Kent Summers, PHARM DNPI 1720076037
Title
Managing Member
Phone
(660) 885-3034

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary
Compounding Pharmacy 3336C0004X NU

Addresses

Primary practice location

895 W College St
Marshall, MO 65340-2912

Mailing address

605 Pawnee St
Clinton, MO 64735-2757
Phone (660) 383-1910

Other identifiers 1

IdentifierTypeStateIssuer
600068258MedicaidMO

Other names 1

  • Summers Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190819001230 MO Part B Supplier - Mass Immunization (Roster Biller Only) 2264760016 Practice locations: Marshall, MO
O20210708003413 MO DME Supplier - Pharmacy 2264760016 Practice locations: Marshall, MO

National Provider Directory

National Provider Directory
Tax ID family
Summers Pharmacy3 organizations share this tax ID, including this one
Part of
Summers Pharmacy

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

895 W College St
Marshall, MO 65340
Phone (660) 831-5220

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642377600000",
    "number": "1518423946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 PAWNEE ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647352757",
            "telephone_number": "660-383-1910",
            "fax_number": "660-885-5888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 W COLLEGE ST",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653402912",
            "telephone_number": "660-831-5220",
            "fax_number": "660-530-4522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERS PHARMACY OF MARSHALL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMERS PHARMACY OF WARRENSBURG, LLC",
        "enumeration_date": "2019-02-11",
        "last_updated": "2022-01-17",
        "certification_date": "2022-01-17",
        "status": "A",
        "authorized_official_last_name": "SUMMERS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "660-885-3034",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600068258",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summers Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Summers Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshall, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.