Provider Demographics
NPI:1164184040
Name:HYYOOT, FRED
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:HYYOOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 PARADISE RD APT 3D
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1393
Mailing Address - Country:US
Mailing Address - Phone:617-306-8785
Mailing Address - Fax:
Practice Address - Street 1:1006 PARADISE RD APT 3D
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1393
Practice Address - Country:US
Practice Address - Phone:617-306-8785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist