Provider Demographics
NPI:1235754078
Name:LIFECARE PHARMACY 2 LLC
Entity Type:Organization
Organization Name:LIFECARE PHARMACY 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PREM
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIDINDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-769-8014
Mailing Address - Street 1:CRAWFORD PHARMACY
Mailing Address - Street 2:2602 N MAIN AVE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212
Mailing Address - Country:US
Mailing Address - Phone:210-881-0890
Mailing Address - Fax:
Practice Address - Street 1:CRAWFORD PHARMACY
Practice Address - Street 2:407 E ORANGE AVE
Practice Address - City:ORANGE GROVE
Practice Address - State:TX
Practice Address - Zip Code:78372
Practice Address - Country:US
Practice Address - Phone:361-384-4077
Practice Address - Fax:361-384-4209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFECARE PHARMACY 2 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33272OtherBOARD OF PHARMACY LICENSE