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Organization

NUTS

Active
Other names
Marionville Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN VICTOR TONJUK RPH. (PHARMACIST IN CHARGE)
(417) 258-2526
Entity
Organization

Contact information

Practice address
201 SOUTH U.S. HIGHWAY 60, MARIONVILLE, MO 65705
(417) 258-2526
(417) 463-2211
Mailing address
PO BOX 217, MARIONVILLE, MO 65705-0217
(417) 258-2526
(417) 463-2211

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
005151
MO
3336L0003X
Long Term Care Pharmacy
005151
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2629585
NCPDP NUMBER
05
601199508
MO
Enumeration date
02/21/2007
Last updated
08/28/2018
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