Provider Demographics
NPI:1790098309
Name:HILDEBRAND, LISA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2714
Mailing Address - Country:US
Mailing Address - Phone:210-341-3875
Mailing Address - Fax:210-344-1887
Practice Address - Street 1:6000 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2714
Practice Address - Country:US
Practice Address - Phone:210-341-3875
Practice Address - Fax:210-344-1887
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist