Provider Demographics
NPI:1881256303
Name:HYATT, KENDALL DAVID (PHARMD)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:DAVID
Last Name:HYATT
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 1:2047 LAKE PARK DR SE APT L
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7678
Mailing Address - Country:US
Mailing Address - Phone:706-302-0226
Mailing Address - Fax:
Practice Address - Street 1:3721 NEW MACLAND RD STE 300
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2088
Practice Address - Country:US
Practice Address - Phone:770-222-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-04
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist