Healthcare Provider Details

I. General information

NPI: 1770160905
Provider Name (Legal Business Name): HASIBA QUDRATULLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 07/28/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17431 RANCHO DIANA
SAN ANTONIO TX
78255-3365
US

IV. Provider business mailing address

17431 RANCHO DIANA
SAN ANTONIO TX
78255-3365
US

V. Phone/Fax

Practice location:
  • Phone: 210-900-0329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74310
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: