Provider Demographics
NPI:1033417662
Name:HYATT, JACQUELINE C (PHARM D)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:C
Last Name:HYATT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MORNING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:GA
Mailing Address - Zip Code:30179-5373
Mailing Address - Country:US
Mailing Address - Phone:404-434-7077
Mailing Address - Fax:
Practice Address - Street 1:3687 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2385
Practice Address - Country:US
Practice Address - Phone:770-577-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist