Organization
FIESTA LIFECARE PHARMACY 3 LLC
Active
Organization
FIESTA LIFECARE PHARMACY 3 LLC
Active
Other names
Galveston Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PREM KALIDINDI (OFFICER)
(917) 769-8014
Entity
Organization
Contact information
Practice address
707 23RD ST, SUITE F, GALVESTON, TX 77550
(409) 877-7029
(281) 549-5957
Mailing address
707 23RD ST, SUITE F, GALVESTON, TX 77550
(409) 877-7029
(281) 549-5957
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31265
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14594
—
TX
05
—
150052
—
TX
01
—
2164062
PK
—
Enumeration date
11/15/2016
Last updated
12/13/2019
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