NPIMap

Organization Active NPI

Medizine Man Inc.

  • Community/Retail Pharmacy
  • Brighton, CO
National Provider Identifier
1730384355
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
690 Issued in CO
Legal business name
MEDIZINE MAN INC.
Practice address
1610 Prairie Center Pkwy
Suite 2110
Brighton, CO 80601-4000
Phone
(303) 483-7455
Fax
(303) 483-7456
NPI assigned
Jun 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Thomas Gierwatoski, R.PH.NPI 1962077966
Title
President
Phone
(970) 640-7698

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 690 CO Primary

Addresses

Primary practice location

1610 Prairie Center Pkwy
Suite 2110
Brighton, CO 80601-4000

Mailing address

1610 Prairie Center Pkwy
Suite 2110
Brighton, CO 80601-4000
Phone (303) 483-7455

Other identifiers 2

IdentifierTypeStateIssuer
36776858MedicaidCO
0620369OtherCONCPDP NUMBER

Other names 1

  • Platte Valley Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201124001704 CO Part B Supplier - Mass Immunization (Roster Biller Only) 9931403094 Practice locations: Brighton, CO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1730384355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 PRAIRIE CENTER PKWY",
            "address_2": "SUITE 2110",
            "city": "BRIGHTON",
            "state": "CO",
            "postal_code": "806014000",
            "telephone_number": "303-483-7455",
            "fax_number": "303-483-7456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 PRAIRIE CENTER PKWY",
            "address_2": "SUITE 2110",
            "city": "BRIGHTON",
            "state": "CO",
            "postal_code": "806014000",
            "telephone_number": "303-483-7455",
            "fax_number": "303-483-7456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIZINE MAN INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-15",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "GIERWATOSKI",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-640-7698",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CO",
            "license": "690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36776858",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "0620369",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Platte Valley Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brighton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.