National Provider Identifier Database

FIESTA LIFECARE PHARMACY 3 LLC
Community/Retail Pharmacy

A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.


Contact Information

FIESTA LIFECARE PHARMACY 3 LLC
707 23RD ST
SUITE F
GALVESTON, TX77550
Phone: 409-877-7029
Fax: 281-549-5957
Website:
Specialty Taxonomy Code
* Community/Retail Pharmacy 3336C0003X
Pharmacy 333600000X

* Indicates primary specialty

NPI Profile & details for FIESTA LIFECARE PHARMACY 3 LLC

NPI Number 1174065643
Legal business name
LBN
FIESTA LIFECARE PHARMACY 3 LLC
Authorized official PREM KALIDINDI - (OFFICER)
Entity Organization
Organization subpart No
Enumeration date 11/15/2016
Last updated 12/13/2019 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • TX License #: 31265
  • TX Medicaid: 14594
  • TX Medicaid: 150052
  • Other: 2164062 PK

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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