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General NPI Number Information
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NPI Number | 1730384355
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Entity Type | Organization
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Legal Business Name | MEDIZINE MAN INC.
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 1610 PRAIRIE CENTER PKWY SUITE 2110
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City | BRIGHTON
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State | CO
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Zip | 80601-4000
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Country | US
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Telephone | 303-483-7455
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Fax | 303-483-7456
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Provider Business Mailing Address
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Address Line | 1610 PRAIRIE CENTER PKWY SUITE 2110
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City | BRIGHTON
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State | CO
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Zip | 80601-4000
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Country | US
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Telephone | 303-483-7455
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Fax | 303-483-7456
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS GIERWATOSKI
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Credential | R.PH.
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Telephone | 970-640-7698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 690
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License Number State | CO
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