MEDICARE: MEDIZINE MAN INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336S0011X	Specialty Pharmacy

General Provider Information

NPI Number	:	1215519889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIZINE MAN INC.

Provider Business Mailing Address
First Line	:	1610 PRAIRIE CENTER PKWY STE 2110
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-4001
Country	:	US
Telephone Number	:	303-483-7455
Fax Number	:	303-483-7456

Provider Business Practice Location Address
First Line	:	1610 PRAIRIE CENTER PKWY STE 2110
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-4001
Country	:	US
Telephone Number	:	303-483-7455
Fax Number	:	303-483-7456

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS PAUL GIERWATOSKI
Credential	:	R.PH.
Telephone Number	:	970-640-7698

Provider Enumeration Date	:	04/23/2021
Last Update Date	:	04/23/2021

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Directions to “MEDIZINE MAN INC. ” Practice Location

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