Organization
CRYSTAL CITY PHARMACY LLC
Active
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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