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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