Organization
MIKE FLINT ENTERPRISES INC
Active
Other names
Mallatt's Pharmacy and Costumes #103
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MICHAEL FLINT JR. (OWNER)
(608) 310-9922
Entity
Organization
Contact information
Practice address
801 N MAIN ST, LODI, WI 53555-1279
(608) 592-3256
(608) 592-7406
Mailing address
801 N MAIN ST, LODI, WI 53555-1279
(608) 592-3256
(608) 592-7406
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9156-42
WI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144324195
—
WI
01
—
2137294
PK
—
Enumeration date
09/12/2006
Last updated
05/18/2015
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