Provider Demographics
NPI:1356009963
Name:TOENJES, ZACHARY THOMAS
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:THOMAS
Last Name:TOENJES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PRAIRIE VIEW EST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-3335
Mailing Address - Country:US
Mailing Address - Phone:618-581-4578
Mailing Address - Fax:
Practice Address - Street 1:407 N STATE ST
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-3053
Practice Address - Country:US
Practice Address - Phone:618-581-4578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021037652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist