Healthcare Provider Details

I. General information

NPI: 1336513928
Provider Name (Legal Business Name): LIFECARE PHARMACY OF DENVER CITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 MUSTANG DR
DENVER CITY TX
79323-2749
US

IV. Provider business mailing address

403 MUSTANG AVE
DENVER CITY TX
79323-2749
US

V. Phone/Fax

Practice location:
  • Phone: 806-592-2765
  • Fax: 806-592-8689
Mailing address:
  • Phone: 806-592-2765
  • Fax: 806-592-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number29152
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

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