Provider Demographics
NPI:1629849831
Name:LIFECARE PHARMACY OF AUSTIN LLC
Entity Type:Organization
Organization Name:LIFECARE PHARMACY OF AUSTIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SREEVIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARVISHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-600-3282
Mailing Address - Street 1:3110 NOGALITOS STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78225-2337
Mailing Address - Country:US
Mailing Address - Phone:210-600-3282
Mailing Address - Fax:210-549-4002
Practice Address - Street 1:3110 NOGALITOS STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-2337
Practice Address - Country:US
Practice Address - Phone:210-600-3282
Practice Address - Fax:210-549-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy