Organization
LIFECARE PHARMACY LTC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PREM KALIDINDI RPH (OWNER)
(210) 881-0890
Entity
Organization
Contact information
Practice address
6609 BLANCO RD STE 312, SAN ANTONIO, TX 78216-6179
(210) 881-0890
Mailing address
PO BOX 12929, SAN ANTONIO, TX 78212-0929
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33956
TEXAS STATE BOARD OF PHARMACY
TX
Enumeration date
10/04/2021
Last updated
10/04/2021
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