Healthcare Provider Details

I. General information

NPI: 1972813723
Provider Name (Legal Business Name): JANALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W WISCONSIN AVE
MILWAUKEE WI
53208-3182
US

IV. Provider business mailing address

PO BOX 13337
MILWAUKEE WI
53213-0337
US

V. Phone/Fax

Practice location:
  • Phone: 414-931-0000
  • Fax: 414-931-0001
Mailing address:
  • Phone: 414-931-0000
  • Fax: 441-931-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9037-042
License Number StateWI

VIII. Authorized Official

Name: HASHIM ZAIBAK
Title or Position: MANAGER
Credential: PHARMD
Phone: 414-712-5200