Summit Express Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Summit, MS
NPI 1720586332 · NPPES record last updated Aug 11, 2022
Key facts
- NPI
- 1720586332
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SUMMIT EXPRESS PHARMACY LLC
- Practice address
- 105 S Laurel St
Summit, MS 39666 - Phone
- (601) 465-0500
- NPI assigned
- Jan 29, 2018
- Organization subpart
- No
Authorized official
- Name
- Marty Bigner
- Title
- Pharmacist
- Phone
- (601) 465-0500
Practitioners 2
-
Tara Lynn Dupree, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2244819 | Summit Express Pharmacy LLC Dba Summit Express | Certificate of waiver | Dec 5, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Summit Express Pharmacy |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181105003102 | MS | Part B Supplier - Mass Immunization (Roster Biller Only) | 7719240662 | Practice locations: Summit, MS |
| O20210920000701 | MS | Part B Supplier - Pharmacy | 7719240662 | Practice locations: Summit, MS |
| O20220324001723 | MS | DME Supplier - Pharmacy | 7719240662 | Practice locations: Summit, MS |
| O20220428001283 | MS | Part B Supplier - Independent Clinical Laboratory | 7719240662 | Practice locations: Summit, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
105 S Laurel St
Summit, MS 39666
Mailing address
PO Box 1310
Summit, MS 39666-1301
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04922559 | Medicaid | MS |
NPI Registry JSON
{
"created_epoch": "1517184000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1660176000000",
"number": "1720586332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1310",
"city": "SUMMIT",
"state": "MS",
"postal_code": "396661301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 S LAUREL ST",
"city": "SUMMIT",
"state": "MS",
"postal_code": "39666",
"telephone_number": "601-465-0500"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SUMMIT EXPRESS PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-01-29",
"last_updated": "2022-08-11",
"certification_date": "2022-05-11",
"status": "A",
"authorized_official_last_name": "BIGNER",
"authorized_official_first_name": "MARTY",
"authorized_official_title_or_position": "PHARMACIST",
"authorized_official_telephone_number": "601-465-0500"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04922559",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Summit, MS
- Dana Stephenson
- Jennifer K. Stogner
- Diane Stringer
- Terri Stringer
- Jasmine Sullivan
- Summit Family Dentistry PLLC
- Lori Tate
- William Taylor
- Amanda Terry
- Elizabeth Terry
All providers in Summit, MS · Community/Retail Pharmacy in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.