Healthcare Provider Details

I. General information

NPI: 1790098309
Provider Name (Legal Business Name): LISA MARIE HILDEBRAND PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 WEST AVE
SAN ANTONIO TX
78213-2714
US

IV. Provider business mailing address

6000 WEST AVE
SAN ANTONIO TX
78213-2714
US

V. Phone/Fax

Practice location:
  • Phone: 210-341-3875
  • Fax: 210-344-1887
Mailing address:
  • Phone: 210-341-3875
  • Fax: 210-344-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42941
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: