Organization
LIFECARE PHARMACY CULEBRA LLC
Active
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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