Provider Demographics
NPI:1184201683
Name:HYLTON, TREVAUGHNE JALEEL
Entity Type:Individual
Prefix:
First Name:TREVAUGHNE
Middle Name:JALEEL
Last Name:HYLTON
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 1:6177 S JOG RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6580
Mailing Address - Country:US
Mailing Address - Phone:561-964-0607
Mailing Address - Fax:561-964-0570
Practice Address - Street 1:6177 S JOG RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6580
Practice Address - Country:US
Practice Address - Phone:561-969-0607
Practice Address - Fax:561-964-0570
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician