MEDICARE: LIFECARE PHARMACY OF DENVER CITY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy	29152	TX
2	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2155285	OTHER		PK

General Provider Information

NPI Number	:	1336513928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFECARE PHARMACY OF DENVER CITY INC

Provider Business Mailing Address
First Line	:	403 MUSTANG AVE
Second Line	:
City	:	DENVER CITY
State	:	TX
Zip	:	79323-2749
Country	:	US
Telephone Number	:	806-592-2765
Fax Number	:	806-592-8689

Provider Business Practice Location Address
First Line	:	403 MUSTANG DR
Second Line	:
City	:	DENVER CITY
State	:	TX
Zip	:	79323-2749
Country	:	US
Telephone Number	:	806-592-2765
Fax Number	:	806-592-8689

Authorized Official
Title or Position	:	PHARMACIST
Name	:	PREM KALIDINDI
Credential	:
Telephone Number	:	917-769-8014

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	12/18/2025

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