Provider Demographics
NPI:1477691327
Name:PITZING, MICHAEL LYNN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYNN
Last Name:PITZING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MULBERRY CT
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303
Mailing Address - Country:US
Mailing Address - Phone:334-677-2993
Mailing Address - Fax:
Practice Address - Street 1:1006 S OATES ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3514
Practice Address - Country:US
Practice Address - Phone:334-794-3174
Practice Address - Fax:334-794-7039
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist