Provider Demographics
NPI:1962801159
Name:MIKE'S PHARMACY, INC
Entity type:Organization
Organization Name:MIKE'S PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PITZING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-794-3174
Mailing Address - Street 1:PO BOX 1826
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-1826
Mailing Address - Country:US
Mailing Address - Phone:334-794-3174
Mailing Address - Fax:334-794-7039
Practice Address - Street 1:11189 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-3475
Practice Address - Country:US
Practice Address - Phone:229-724-4461
Practice Address - Fax:229-724-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy