Provider Demographics
NPI:1790860104
Name:NUTS INC
Entity Type:Organization
Organization Name:NUTS INC
Other - Org Name:MARIONVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TONJUK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-258-2626
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:MARIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65705-0217
Mailing Address - Country:US
Mailing Address - Phone:417-258-2526
Mailing Address - Fax:417-462-2211
Practice Address - Street 1:201 S HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MARIONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65705-9407
Practice Address - Country:US
Practice Address - Phone:417-258-2526
Practice Address - Fax:417-463-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MO0057573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2047195OtherPK
MO601199508Medicaid
2047195OtherPK