Healthcare Provider Details

I. General information

NPI: 1710454186
Provider Name (Legal Business Name): SLG PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 N MAIN AVE
SAN ANTONIO TX
78212-2919
US

IV. Provider business mailing address

PO BOX 12929
SAN ANTONIO TX
78212-0929
US

V. Phone/Fax

Practice location:
  • Phone: 210-881-0890
  • Fax: 210-569-6464
Mailing address:
  • Phone: 917-769-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PREM KALIDINDI
Title or Position: MANAGING MEMBER
Credential: RPH
Phone: 210-881-0890