Healthcare Provider Details

I. General information

NPI: 1336692235
Provider Name (Legal Business Name): LIFECARE PHARMACY OF DALLAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9709 BRUTON RD STE 900
DALLAS TX
75217-2704
US

IV. Provider business mailing address

9709 BRUTON RD STE 900
DALLAS TX
75217-2704
US

V. Phone/Fax

Practice location:
  • Phone: 214-942-7300
  • Fax: 214-942-7302
Mailing address:
  • Phone: 214-942-7300
  • Fax: 214-942-7302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number31263
License Number StateTX

VIII. Authorized Official

Name: PREM KALIDINDI
Title or Position: MANAGING MEMBER
Credential:
Phone: 917-769-8014