MEDICARE: FIDEL G HUERTA JR INC

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	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	25780	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4546276	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1265611578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDEL G HUERTA JR INC

Provider Business Mailing Address
First Line	:	102 BABCOCK RD
Second Line	:	STE 102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-3952
Country	:	US
Telephone Number	:	210-737-6000
Fax Number	:	210-737-6024

Provider Business Practice Location Address
First Line	:	102 BABCOCK RD
Second Line	:	STE 102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-3952
Country	:	US
Telephone Number	:	210-737-6000
Fax Number	:	210-737-6024

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FIDEL HUERTA
Credential	:	RPH
Telephone Number	:	210-433-9991

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	01/28/2011

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Directions to “FIDEL G HUERTA JR INC ” Practice Location

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