Provider Demographics
NPI:1326740432
Name:MILWAUKEE PHARMACY LLC
Entity Type:Organization
Organization Name:MILWAUKEE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELZEIBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-344-5024
Mailing Address - Street 1:2400 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-1201
Mailing Address - Country:US
Mailing Address - Phone:414-442-8760
Mailing Address - Fax:414-442-8761
Practice Address - Street 1:1134 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1333
Practice Address - Country:US
Practice Address - Phone:414-442-8760
Practice Address - Fax:414-442-8761
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILWAUKEE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy