Provider Demographics
NPI:1043525405
Name:BULLOCK, HUBERT HORACE JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:HUBERT
Middle Name:HORACE
Last Name:BULLOCK
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11551 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1343
Mailing Address - Country:US
Mailing Address - Phone:210-340-7786
Mailing Address - Fax:210-308-0138
Practice Address - Street 1:11551 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1343
Practice Address - Country:US
Practice Address - Phone:210-340-7786
Practice Address - Fax:210-308-0138
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist