Healthcare Provider Details

I. General information

NPI: 1013348572
Provider Name (Legal Business Name): HAYAT PHARMACY 8, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W MAIN ST
CAMPBELLSPORT WI
53010-2704
US

IV. Provider business mailing address

PO BOX 13337
MILWAUKEE WI
53213-0337
US

V. Phone/Fax

Practice location:
  • Phone: 920-533-4012
  • Fax: 920-533-4012
Mailing address:
  • Phone: 920-533-4012
  • Fax: 920-533-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9232-42
License Number StateWI

VIII. Authorized Official

Name: HASHIM ZAIBAK
Title or Position: OWNER
Credential: PHARMACIST
Phone: 414-712-5200