Provider Demographics
NPI:1164817540
Name:LIFECARE REUSS PHARMACY LLC
Entity Type:Organization
Organization Name:LIFECARE REUSS PHARMACY LLC
Other - Org Name:REUSS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIDINDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-268-2030
Mailing Address - Street 1:7267 NOTRE DAME DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3523
Mailing Address - Country:US
Mailing Address - Phone:361-275-3411
Mailing Address - Fax:361-275-7383
Practice Address - Street 1:515 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-3603
Practice Address - Country:US
Practice Address - Phone:361-275-3411
Practice Address - Fax:361-275-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30017OtherPHARMACY LICENSE
TX148469Medicaid
7362040001Medicare NSC