Organization
CRYSTAL CITY PHARMACY LLC
Active
Other names
Crystal City Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
PREM KALIDINDI (BOARD MEMBER)
(917) 769-8014
Entity
Organization
Contact information
Practice address
1313 VETERANS AVE STE I, CRYSTAL CITY, TX 78839-1651
(830) 255-2201
(830) 448-2020
Mailing address
PO BOX 12929, SAN ANTONIO, TX 78212
(210) 881-0890
(210) 569-6464
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31441
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149678
—
TX
01
—
2170975
PK
—
Enumeration date
08/14/2017
Last updated
12/18/2025
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