Healthcare Provider Details

I. General information

NPI: 1356009963
Provider Name (Legal Business Name): ZACHARY THOMAS TOENJES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N STATE ST
DESLOGE MO
63601-3053
US

IV. Provider business mailing address

11 PRAIRIE VIEW EST
COLUMBIA IL
62236-3335
US

V. Phone/Fax

Practice location:
  • Phone: 618-581-4578
  • Fax:
Mailing address:
  • Phone: 618-581-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021037652
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: