MEDICARE: DIEGO RICARDO HERNANDEZ PHARMD

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	74817	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1447837505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIEGO RICARDO HERNANDEZ PHARMD

Provider Business Mailing Address
First Line	:	2255 THOUSAND OAKS DR APT 4105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3983
Country	:	US
Telephone Number	:	956-890-0434
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 E HILDEBRAND AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-2535
Country	:	US
Telephone Number	:	210-883-1000
Fax Number	:

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

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	09/26/2024

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