Organization
LIFECARE PHARMACY BARLITE
Active
Organization
LIFECARE PHARMACY BARLITE
Active
Other names
Fiesta Lifecare Pharmacy 2 LLC
Organization subpart
No
Provider details
NPI number
Authorized official
PREM KALIDINDI (BOARD MEMBER)
(917) 769-8014
Entity
Organization
Contact information
Practice address
7355 BARLITE BLVD STE 101B, SAN ANTONIO, TX 78224-1340
(210) 817-4231
(210) 817-4232
Mailing address
PO BOX 12929, SAN ANTONIO, TX 78212-0929
(210) 881-0890
(210) 569-6464
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31264
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149593
—
TX
01
—
2164649
PK
—
Enumeration date
10/27/2016
Last updated
09/19/2025
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