Provider Demographics
NPI:1801499041
Name:MIKHAEIL, ISHAK ZAKARIA BEKHIT
Entity type:Individual
Prefix:
First Name:ISHAK
Middle Name:ZAKARIA BEKHIT
Last Name:MIKHAEIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 SILVERNAIL RD
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5526
Mailing Address - Country:US
Mailing Address - Phone:262-547-6343
Mailing Address - Fax:
Practice Address - Street 1:2160 SILVERNAIL RD
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5526
Practice Address - Country:US
Practice Address - Phone:262-547-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI197761835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist