Organization
LIFECARE PHARMACY YUMA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PREM KALIDINDI (MANAGING MEMBER)
(917) 769-8014
Entity
Organization
Contact information
Practice address
2514 SOUTH AVE A, SUITE 2, YUMA, AZ 85365
(210) 881-0890
Mailing address
PO BOX 12929, SAN ANTONIO, TX 78212-0929
(210) 881-0890
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
YOO7848
STATE BOARD OF PHARMACY REATIL PHARMACY
AZ
Enumeration date
08/22/2019
Last updated
08/22/2019
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