MEDICARE: HAYAT PHARMACY 9 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	9402-42	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2159735	OTHER		PK

General Provider Information

NPI Number	:	1053766071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYAT PHARMACY 9 LLC

Provider Business Mailing Address
First Line	:	PO BOX 13337
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-0337
Country	:	US
Telephone Number	:	414-509-2222
Fax Number	:	414-509-2221

Provider Business Practice Location Address
First Line	:	8434 W SILVER SPRING DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-2824
Country	:	US
Telephone Number	:	414-509-2222
Fax Number	:	414-509-2221

Authorized Official
Title or Position	:	OWNER/CEO/PIC/AO
Name	:	HASHIM ZAIBAK
Credential	:	PHARMD
Telephone Number	:	414-712-5200

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	09/23/2016

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