Provider Demographics
NPI:1326643339
Name:HIDALGO, JESUS R JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:R
Last Name:HIDALGO
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 E 1500 RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-9267
Mailing Address - Country:US
Mailing Address - Phone:785-760-0292
Mailing Address - Fax:
Practice Address - Street 1:3901 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3356
Practice Address - Country:US
Practice Address - Phone:785-273-1106
Practice Address - Fax:785-273-1291
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist