MEDICARE: MIKES PHARMACY OF HEADLAND 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	114535	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2154941	OTHER		PK

General Provider Information

NPI Number	:	1952773814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKES PHARMACY OF HEADLAND INC

Provider Business Mailing Address
First Line	:	202 HOLMAN DR
Second Line	:
City	:	HEADLAND
State	:	AL
Zip	:	36345-2307
Country	:	US
Telephone Number	:	334-693-3324
Fax Number	:	334-693-5051

Provider Business Practice Location Address
First Line	:	202 HOLMAN DR
Second Line	:
City	:	HEADLAND
State	:	AL
Zip	:	36345-2307
Country	:	US
Telephone Number	:	334-693-3324
Fax Number	:	334-693-5051

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL PITZING
Credential	:
Telephone Number	:	334-701-9549

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	09/19/2025

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