Provider Demographics
NPI:1659782142
Name:HAZLETT, NATHANIEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:HAZLETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH VERSAILLES
Mailing Address - State:PA
Mailing Address - Zip Code:15137-2736
Mailing Address - Country:US
Mailing Address - Phone:412-823-7270
Mailing Address - Fax:
Practice Address - Street 1:1901 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:NORTH VERSAILLES
Practice Address - State:PA
Practice Address - Zip Code:15137-2736
Practice Address - Country:US
Practice Address - Phone:412-823-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist