MEDICARE: HAYAT PHARMACY 5 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	9058-042	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2128884	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114224649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYAT PHARMACY 5 LLC

Provider Business Mailing Address
First Line	:	1919 W NORTH AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1155
Country	:	US
Telephone Number	:	414-374-0000
Fax Number	:	414-374-0001

Provider Business Practice Location Address
First Line	:	1919 W NORTH AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1153
Country	:	US
Telephone Number	:	414-374-0000
Fax Number	:	414-374-0001

Authorized Official
Title or Position	:	OWNER
Name	:	HASHIM ZAIBAK
Credential	:
Telephone Number	:	414-374-0000

Provider Enumeration Date	:	02/18/2011
Last Update Date	:	10/19/2023

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Directions to “HAYAT PHARMACY 5 LLC ” Practice Location

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