MEDICARE: HAYAT PHARMACY 8, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	9232-42	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2143357	OTHER		PK

General Provider Information

NPI Number	:	1013348572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYAT PHARMACY 8, LLC

Provider Business Mailing Address
First Line	:	PO BOX 13337
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-0337
Country	:	US
Telephone Number	:	920-533-4012
Fax Number	:	920-533-3408

Provider Business Practice Location Address
First Line	:	110 W MAIN ST
Second Line	:
City	:	CAMPBELLSPORT
State	:	WI
Zip	:	53010-2704
Country	:	US
Telephone Number	:	920-533-4012
Fax Number	:	920-533-4012

Authorized Official
Title or Position	:	OWNER
Name	:	HASHIM ZAIBAK
Credential	:	PHARMACIST
Telephone Number	:	414-712-5200

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	04/17/2020

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