1184713414 NPI number — PITZING PHARMACEUTICALS INC

Table of content: (NPI 1184713414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184713414 NPI number — PITZING PHARMACEUTICALS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PITZING PHARMACEUTICALS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MIKE'S SOUTHSIDE PHARYMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184713414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1006 S OATES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36301-3514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-794-3174
Provider Business Mailing Address Fax Number:
334-794-7039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1006 S OATES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-794-3174
Provider Business Practice Location Address Fax Number:
334-794-7039
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PITZING
Authorized Official First Name:
MICHEAL
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PRESIDENT/PHARMACIST
Authorized Official Telephone Number:
334-794-3174

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  112316 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100003265 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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