MEDICARE: ROBERTA JANE HILDEBRAND R.PH.

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	21002	TX

General Provider Information

NPI Number	:	1023289972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA JANE HILDEBRAND R.PH.

Provider Business Mailing Address
First Line	:	6480 VALLEY RIDGE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-9512
Country	:	US
Telephone Number	:	817-925-7933
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 E BELKNAP ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76111-6609
Country	:	US
Telephone Number	:	817-834-3001
Fax Number	:	817-834-0710

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

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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