# MIKE FLINT ENTERPRISES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mallatt's Pharmacy and Costumes \#103
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144324195
- **Authorized official:** JOHN MICHAEL FLINT JR. (OWNER)
- **Authorized official phone:** (608) 310-9922

## Contact information

- **Practice address:** 801 N MAIN ST, LODI, WI 53555-1279
- **Practice address phone:** (608) 592-3256
- **Practice address fax:** (608) 592-7406
- **Mailing address:** 801 N MAIN ST, LODI, WI 53555-1279
- **Mailing address phone:** (608) 592-3256
- **Mailing address fax:** (608) 592-7406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9156-42 | WI | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/12/2006
- **Last updated:** 05/18/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1144324195 | — | WI |
| 01 | — | 2137294 | PK | — |