Provider Demographics
NPI:1306123138
Name:HYATT, LOIS SR
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:HYATT
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2353
Mailing Address - Country:US
Mailing Address - Phone:803-327-2081
Mailing Address - Fax:803-327-3585
Practice Address - Street 1:1237 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2353
Practice Address - Country:US
Practice Address - Phone:803-327-2081
Practice Address - Fax:803-327-3585
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10553183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician