Healthcare Provider Details

I. General information

NPI: 1174531347
Provider Name (Legal Business Name): TOLSON DRUG COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 E. HIGH ST
JEFFERSON CITY MO
65101-1051
US

IV. Provider business mailing address

226 E HIGH ST
JEFFERSON CITY MO
65101-3207
US

V. Phone/Fax

Practice location:
  • Phone: 573-636-4022
  • Fax: 573-635-7687
Mailing address:
  • Phone: 573-636-4022
  • Fax: 573-635-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number002467
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHANE M BECKER
Title or Position: OWNER/PRESIDENT
Credential: PHARMACIST
Phone: 573-636-4022