MEDICARE: MARVIN A HYATT JR. RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	006798	SC

General Provider Information

NPI Number	:	1447461322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVIN A HYATT JR. RPH

Provider Business Mailing Address
First Line	:	2627 CARROLWOOD DR
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1557
Country	:	US
Telephone Number	:	803-328-5981
Fax Number	:	803-327-3585

Provider Business Practice Location Address
First Line	:	1237 EBENEZER RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2353
Country	:	US
Telephone Number	:	803-327-2081
Fax Number	:	803-327-3585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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