Provider Demographics
NPI:1467746586
Name:EZZAT, HAYAT A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HAYAT
Middle Name:A
Last Name:EZZAT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 13TH AVE SE
Mailing Address - Street 2:APT 1804
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2065
Mailing Address - Country:US
Mailing Address - Phone:612-205-3384
Mailing Address - Fax:
Practice Address - Street 1:425 13TH AVE SE
Practice Address - Street 2:APT 1804
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2065
Practice Address - Country:US
Practice Address - Phone:612-205-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist