Organization
MIKE FLINT ENTERPRISES INC
Active
Other names
Mallatt's Pharmacy and Costumes #102
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MICHAEL FLINT JR. (OWNER)
(608) 310-9922
Entity
Organization
Contact information
Practice address
233 S CENTURY AVE, WAUNAKEE, WI 53597-1249
(608) 849-7888
(608) 849-7474
Mailing address
233 S CENTURY AVE, WAUNAKEE, WI 53597-1249
(608) 849-7888
(608) 849-7474
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9155-42
WI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962506915
—
WI
01
—
2137291
PK
—
05
—
33015500
—
WI
Enumeration date
09/12/2006
Last updated
05/18/2015
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