Provider Demographics
NPI:1023289972
Name:HILDEBRAND, ROBERTA JANE (RPH)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JANE
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 VALLEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-9512
Mailing Address - Country:US
Mailing Address - Phone:817-925-7933
Mailing Address - Fax:
Practice Address - Street 1:4004 E BELKNAP ST
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76111-6609
Practice Address - Country:US
Practice Address - Phone:817-834-3001
Practice Address - Fax:817-834-0710
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist