Provider Demographics
NPI:1053324681
Name:HYATT'S MARKET INC
Entity Type:Organization
Organization Name:HYATT'S MARKET INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-747-6066
Mailing Address - Street 1:70 MCHANN RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:AL
Mailing Address - Zip Code:35540-2138
Mailing Address - Country:US
Mailing Address - Phone:256-747-6066
Mailing Address - Fax:256-747-6046
Practice Address - Street 1:70 MCHANN RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:AL
Practice Address - Zip Code:35540-2138
Practice Address - Country:US
Practice Address - Phone:256-747-6066
Practice Address - Fax:256-747-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003169Medicaid
AL0130031OtherNABP NUMBER
AL009961470OtherMEDICAID DME NUMBER
AL009961470OtherMEDICAID DME NUMBER
AL1324020001Medicare NSC