Provider Demographics
NPI:1578877296
Name:MIKE FLINT ENTERPRISES INC
Entity Type:Organization
Organization Name:MIKE FLINT ENTERPRISES INC
Other - Org Name:MALLATT PHARMACY AND COSTUME 101
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FLINT
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:608-310-9922
Mailing Address - Street 1:1255 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3754
Mailing Address - Country:US
Mailing Address - Phone:608-255-9116
Mailing Address - Fax:608-255-9969
Practice Address - Street 1:1255 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3754
Practice Address - Country:US
Practice Address - Phone:608-255-9116
Practice Address - Fax:608-255-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9024-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy