Provider Demographics
NPI:1760885297
Name:KALI NAGABALAJI
Entity Type:Organization
Organization Name:KALI NAGABALAJI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGIRIKONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-903-9772
Mailing Address - Street 1:200 W J BOAZ RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179
Mailing Address - Country:US
Mailing Address - Phone:817-405-3333
Mailing Address - Fax:817-405-3341
Practice Address - Street 1:200 W J BOAZ RD
Practice Address - Street 2:STE 100
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179
Practice Address - Country:US
Practice Address - Phone:817-405-3333
Practice Address - Fax:817-405-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX295373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29537OtherTEXAS STATE BOARD OF PHARMACY