Provider Demographics
NPI:1215519889
Name:MEDIZINE MAN INC.
Entity type:Organization
Organization Name:MEDIZINE MAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GIERWATOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:970-640-7698
Mailing Address - Street 1:1610 PRAIRIE CENTER PKWY STE 2110
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4001
Mailing Address - Country:US
Mailing Address - Phone:303-483-7455
Mailing Address - Fax:303-483-7456
Practice Address - Street 1:1610 PRAIRIE CENTER PKWY STE 2110
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4001
Practice Address - Country:US
Practice Address - Phone:303-483-7455
Practice Address - Fax:303-483-7456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDIZINE MAN INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy