Provider Demographics
NPI:1750622551
Name:TONJUK, JOHN VICTOR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VICTOR
Last Name:TONJUK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S HIGHWAY 60
Mailing Address - Street 2:P.O. BOX 217
Mailing Address - City:MARIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65705-9407
Mailing Address - Country:US
Mailing Address - Phone:417-258-2526
Mailing Address - Fax:417-463-2211
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
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0402151835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO601199508Medicaid
MO040215OtherMISSOURI PHARMACIST LICENSE
MO2629585OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MO601199508Medicaid