Provider Demographics
NPI:1982257200
Name:HAYAT PHARMACY 16 LLC
Entity Type:Organization
Organization Name:HAYAT PHARMACY 16 LLC
Other - Org Name:HAYAT PHARMACY 16
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KALOTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:414-543-9999
Mailing Address - Street 1:PO BOX 13337
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-0337
Mailing Address - Country:US
Mailing Address - Phone:414-543-9999
Mailing Address - Fax:414-483-0006
Practice Address - Street 1:603 N 36TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3826
Practice Address - Country:US
Practice Address - Phone:414-543-9999
Practice Address - Fax:414-483-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI957642OtherSTATE OF WISCONSIN LICENSE