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General NPI Number Information
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NPI Number | 1760885297
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Entity Type | Organization
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Legal Business Name | KALI NAGABALAJI
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 200 W J BOAZ RD STE 100
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City | SAGINAW
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State | TX
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Zip | 76179
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Country | US
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Telephone | 817-405-3333
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Fax | 817-405-3341
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Provider Business Mailing Address
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Address Line | 200 W J BOAZ RD STE 100
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City | SAGINAW
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State | TX
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Zip | 76179
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Country | US
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Telephone | 817-405-3333
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Fax | 817-405-3341
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Authorized Official
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Title or Position | MANAGING OFFICER
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Name | MR. KISHORE SINGIRIKONDA
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Credential |
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Telephone | 269-903-9772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 29537
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License Number State | TX
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