Provider Demographics
NPI:1013002930
Name:MIZE, HOWARD JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:JOHN
Last Name:MIZE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 SEQUIOA TRAIL
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593
Mailing Address - Country:US
Mailing Address - Phone:608-798-1315
Mailing Address - Fax:
Practice Address - Street 1:639 S MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1478
Practice Address - Country:US
Practice Address - Phone:608-846-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8946-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33266000Medicaid
WI33266000Medicaid