Healthcare Provider Details

I. General information

NPI: 1699102699
Provider Name (Legal Business Name): MR. PREM S. KALIDINDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7267 NOTRE DAME DR STE 1
IRVING TX
75063-3523
US

IV. Provider business mailing address

7267 NOTRE DAME DR
IRVING TX
75063-3523
US

V. Phone/Fax

Practice location:
  • Phone: 210-881-0474
  • Fax: 210-569-6464
Mailing address:
  • Phone: 917-769-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52701
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: