Provider Demographics
NPI:1295054989
Name:HYATT, DONALD C
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:C
Last Name:HYATT
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 1:2320 MOORES MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-8402
Mailing Address - Country:US
Mailing Address - Phone:334-887-8780
Mailing Address - Fax:334-887-8786
Practice Address - Street 1:2320 MOORES MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8402
Practice Address - Country:US
Practice Address - Phone:334-887-8780
Practice Address - Fax:334-887-8786
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL122691835P0018X, 183500000X
GARPH018207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL121350Medicaid
AL6483360001Medicare NSC