Provider Demographics
NPI:1659620011
Name:HYATT, LAURA L (RPH)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:L
Last Name:HYATT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 JOHNNIE DODDS BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3013
Mailing Address - Country:US
Mailing Address - Phone:843-849-3471
Mailing Address - Fax:843-216-0751
Practice Address - Street 1:650 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3013
Practice Address - Country:US
Practice Address - Phone:843-849-3471
Practice Address - Fax:843-216-0751
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist