NPIMap

Organization Active NPI

Nuts Inc

Doing business as Marionville Pharmacy

  • Community/Retail Pharmacy
  • Marionville, MO
National Provider Identifier
1790860104
Registry record updated Dec 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
005757 Issued in MO
Legal business name
NUTS INC
Doing business as
Marionville Pharmacy
Practice address
201 S Highway 60
Marionville, MO 65705-9407
Phone
(417) 258-2526
Fax
(417) 463-2211
NPI assigned
Oct 25, 2006
Last updated
Dec 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Tonjuk, RPHNPI 1750622551
Title
Pic
Phone
(417) 258-2626

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 005757 MO Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

201 S Highway 60
Marionville, MO 65705-9407

Mailing address

PO Box 217
Marionville, MO 65705-0217
Phone (417) 258-2526

Other identifiers 2

IdentifierTypeStateIssuer
601199508MedicaidMO
2047195OtherPK

Other names 1

  • MARIONVILLE PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101111000525 MO Part B Supplier - Mass Immunization (Roster Biller Only) 5294855706 Practice locations: Marionville, MO

National Provider Directory

National Provider Directory

Locations

201 S Highway 60
Marionville, MO 65705
Phone (417) 258-2526

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1790860104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "MARIONVILLE",
            "state": "MO",
            "postal_code": "657050217",
            "telephone_number": "417-258-2526",
            "fax_number": "417-462-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S HIGHWAY 60",
            "city": "MARIONVILLE",
            "state": "MO",
            "postal_code": "657059407",
            "telephone_number": "417-258-2526",
            "fax_number": "417-463-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "TONJUK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "417-258-2626",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "005757",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "601199508",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2047195",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARIONVILLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marionville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.