Organization
LIFECARE PHARMACY CULEBRA LLC
Active
Other names
Lifecare Pharmacy Culebra
Organization subpart
No
Provider details
NPI number
Authorized official
PREM KALIDINDI (MANAGING PARTNER)
(917) 769-8014
Entity
Organization
Contact information
Practice address
7614 CULEBRA RD STE 101, SAN ANTONIO, TX 78251-1477
(210) 769-8014
(210) 569-6464
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
31362
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149670
—
TX
01
—
2168983
PK
—
Enumeration date
04/26/2017
Last updated
07/27/2018
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