Healthcare Provider Details

I. General information

NPI: 1396093175
Provider Name (Legal Business Name): CRAWFORD PHARMACY OF PLEASANTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 09/19/2025
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W HART AVE STE 104
SAN ANTONIO TX
78214-1491
US

IV. Provider business mailing address

CRAWFORD PHARMACY PO BOX 12929
SAN ANTONIO TX
78212
US

V. Phone/Fax

Practice location:
  • Phone: 210-932-1200
  • Fax: 210-932-1201
Mailing address:
  • Phone: 917-769-8014
  • Fax: 210-569-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28182
License Number StateTX

VIII. Authorized Official

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