1578033718 NPI number — HAYAT PHARMACY 14

Table of content: MS. ERIKA LUNA ADDICTION COUNSELOR (NPI 1841529658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578033718 NPI number — HAYAT PHARMACY 14

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAYAT PHARMACY 14
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578033718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13337
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53213-0337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-464-5555
Provider Business Mailing Address Fax Number:
414-464-5511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 W SILVER SPRING DR STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53209-4217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-464-5555
Provider Business Practice Location Address Fax Number:
414-464-5511
Provider Enumeration Date:
11/30/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZAIBAK
Authorized Official First Name:
HASHIM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
414-464-5555

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)