Organization · NPI-2

Fiesta Lifecare Pharmacy 3 LLC

Pharmacy, Community/Retail Pharmacy · Galveston, TX

NPI number1174065643
StatusActive
Last updated in NPPESDec 13, 2019

Details

NPI
1174065643
Entity type
Organization (NPI-2)
Legal business name
Fiesta Lifecare Pharmacy 3 LLC
Organization subpart
No
Enumeration date
Nov 15, 2016
Certification date
Dec 13, 2019
Last updated
Dec 13, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3336C0003X Pharmacy, Community/Retail Pharmacy31265TXYes
333600000X Pharmacy––

Other names

  • Galveston Specialty Pharmacy (Doing Business As)

Practice location

707 23rd St
Suite F
Galveston, TX 77550

Phone 409-877-7029 · Fax 281-549-5957

Mailing address

707 23rd St
Suite F
Galveston, TX 77550

Phone 409-877-7029 · Fax 281-549-5957

Authorized official

Prem Kalidindi
Officer
9177698014

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