Organization
PRASANNA LLC
Active
Other names
MEDICAL CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PRAVALIKA KALI (OWNER)
(210) 534-5457
Entity
Organization
Contact information
Practice address
1342 FAIR AVE, SAN ANTONIO, TX 78223
(210) 534-5457
(210) 532-4747
Mailing address
1342 FAIR AVE, SAN ANTONIO, TX 78223
(210) 534-5457
(210) 532-4747
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2619
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013563401
—
TX
05
—
091506801
—
TX
01
—
2090476
PK
—
Enumeration date
11/17/2006
Last updated
12/18/2019
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