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General NPI Number Information
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NPI Number | 1043627938
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Entity Type | Organization
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Legal Business Name | MAHA KALI NAGA BALAJI LLC
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Dates
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Enumeration Date | 07/13/2014
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 13601 PRESTON RD STE 720E
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City | DALLAS
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State | TX
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Zip | 75240-4920
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Country | US
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Telephone | 972-552-2666
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Fax | 972-552-2675
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Provider Business Mailing Address
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Address Line | 13601 PRESTON RD SUITE 720E
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City | DALLAS
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State | TX
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Zip | 75240-4911
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Country | US
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Telephone | 972-552-2666
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Fax | 972-552-2675
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Authorized Official
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Title or Position | CREDENTIALING CONTACT
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Name | NIZAR ALIKHAN
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Credential |
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Telephone | 972-552-2666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 29345
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License Number State | TX
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