Provider Demographics
NPI:1033513817
Name:PITZ, GINA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:PITZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1425
Mailing Address - Country:US
Mailing Address - Phone:608-776-4481
Mailing Address - Fax:608-776-2341
Practice Address - Street 1:327 MAIN ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1425
Practice Address - Country:US
Practice Address - Phone:608-776-4481
Practice Address - Fax:608-776-2341
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12551-40183500000X
IL051.039461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist