Healthcare Provider Details

I. General information

NPI: 1164817540
Provider Name (Legal Business Name): LIFECARE REUSS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N ESPLANADE ST
CUERO TX
77954-3603
US

IV. Provider business mailing address

7267 NOTRE DAME DR
IRVING TX
75063-3523
US

V. Phone/Fax

Practice location:
  • Phone: 361-275-3411
  • Fax: 361-275-7383
Mailing address:
  • Phone: 361-275-3411
  • Fax: 361-275-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: VIJAYA KALIDINDI
Title or Position: MANAGING MEMBER
Credential:
Phone: 505-268-2030