Provider Demographics
NPI:1922361138
Name:MEDIZINE MAN INC.
Entity Type:Organization
Organization Name:MEDIZINE MAN INC.
Other - Org Name:PLATTE VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GIERWATOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:970-640-7698
Mailing Address - Street 1:13802 DEXTER WAY
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-9626
Mailing Address - Country:US
Mailing Address - Phone:970-640-7698
Mailing Address - Fax:303-955-0684
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-483-7455
Practice Address - Fax:303-483-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy