Organization
LIFECARE PHARMACY 21 INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PREM KALIDINDI RPH (MANAGING MEMBER)
(917) 769-8014
Entity
Organization
Contact information
Practice address
511 N ESPLANADE ST, CUERO, TX 77954-3603
(210) 881-0890
(210) 569-6464
Mailing address
PO BOX 12929, SAN ANTONIO, TX 78212-0929
(210) 881-0890
(210) 569-6464
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
—
—
Other
Enumeration date
12/02/2021
Last updated
12/02/2021
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