Provider Demographics
NPI:1679556179
Name:HYATT, JUDSON FLETCHER (PHARMACIIST)
Entity Type:Individual
Prefix:MR
First Name:JUDSON
Middle Name:FLETCHER
Last Name:HYATT
Suffix:
Gender:M
Credentials:PHARMACIIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7541
Mailing Address - Country:US
Mailing Address - Phone:541-779-1781
Mailing Address - Fax:
Practice Address - Street 1:2900 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8380
Practice Address - Country:US
Practice Address - Phone:541-789-5969
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist