Healthcare Provider Details

I. General information

NPI: 1891830238
Provider Name (Legal Business Name): NUTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SOUTH U.S. HIGHWAY 60
MARIONVILLE MO
65705
US

IV. Provider business mailing address

PO BOX 217
MARIONVILLE MO
65705-0217
US

V. Phone/Fax

Practice location:
  • Phone: 417-258-2526
  • Fax: 417-463-2211
Mailing address:
  • Phone: 417-258-2526
  • Fax: 417-463-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number005151
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number005151
License Number StateMO

VIII. Authorized Official

Name: JOHN VICTOR TONJUK
Title or Position: PHARMACIST IN CHARGE
Credential: RPH.
Phone: 417-258-2526