Organization
MAHA KALI NAGA BALAJI LLC
Active
Other names
FORNEY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
NIZAR ALIKHAN (CREDENTIALING CONTACT)
(972) 552-2666
Entity
Organization
Contact information
Practice address
13601 PRESTON RD STE 720E, DALLAS, TX 75240-4920
(972) 552-2666
(972) 552-2675
Mailing address
13601 PRESTON RD, SUITE 720E, DALLAS, TX 75240-4911
(972) 552-2666
(972) 552-2675
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29345
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146856
PK
—
Enumeration date
07/13/2014
Last updated
01/18/2017
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