Provider Demographics
NPI:1679915185
Name:HYATTE, JAMES CARL (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CARL
Last Name:HYATTE
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 1:5307 BROADWATER DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3867
Mailing Address - Country:US
Mailing Address - Phone:336-830-1388
Mailing Address - Fax:
Practice Address - Street 1:5001 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4513
Practice Address - Country:US
Practice Address - Phone:336-659-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist