MEDICARE: FITZGERALD 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

General Provider Information

NPI Number	:	1235771759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FITZGERALD LLC

Provider Business Mailing Address
First Line	:	PO BOX 13337
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213-0337
Country	:	US
Telephone Number	:	414-909-1111
Fax Number	:	414-909-1992

Provider Business Practice Location Address
First Line	:	424 E SILVER SPRING DR
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-5224
Country	:	US
Telephone Number	:	414-909-1111
Fax Number	:	414-909-1992

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

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	06/20/2022

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Directions to “FITZGERALD LLC ” Practice Location

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