=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982257200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAYAT PHARMACY 16 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2019
-----------------------------------------------------
Last Update Date | 02/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 N 36TH ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53208-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-543-9999
-----------------------------------------------------
Fax | 414-483-0006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 13337
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53213-0337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-543-9999
-----------------------------------------------------
Fax | 414-483-0006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST OWNER
-----------------------------------------------------
Name | TAMIR KALOTI
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 414-543-9999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------