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General NPI Number Information
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NPI Number | 1891830238
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Entity Type | Organization
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Legal Business Name | NUTS
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 201 SOUTH U.S. HIGHWAY 60
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City | MARIONVILLE
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State | MO
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Zip | 65705
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Country | US
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Telephone | 417-258-2526
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Fax | 417-463-2211
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Provider Business Mailing Address
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Address Line | PO BOX 217
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City | MARIONVILLE
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State | MO
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Zip | 65705-0217
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Country | US
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Telephone | 417-258-2526
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Fax | 417-463-2211
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | JOHN VICTOR TONJUK
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Credential | RPH.
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Telephone | 417-258-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 005151
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 005151
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License Number State | MO
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