Provider Demographics
NPI:1093305005
Name:HURT, CHAZ K (DPH)
Entity Type:Individual
Prefix:DR
First Name:CHAZ
Middle Name:K
Last Name:HURT
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S CAROL ST
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:OK
Mailing Address - Zip Code:73015-9064
Mailing Address - Country:US
Mailing Address - Phone:580-515-2429
Mailing Address - Fax:
Practice Address - Street 1:15 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:OK
Practice Address - Zip Code:73015
Practice Address - Country:US
Practice Address - Phone:580-654-1111
Practice Address - Fax:580-654-1229
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist