Fiesta Lifecare Pharmacy 3 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

31265 Issued in TX

Legal business name

FIESTA LIFECARE PHARMACY 3 LLC

Practice address

707 23Rd St
Suite F
Galveston, TX 77550

Phone

(409) 877-7029

Fax

(281) 549-5957

NPI assigned

Nov 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Prem KalidindiNPI 1699102699

Title

Officer

Phone

(917) 769-8014

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Galveston Specialty Pharmacy Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Prem S. Kalidindi

  • Pharmacist
  • Irving, TX
  • NPI 1699102699
  NPD (past) Authorized official
• Gaurav Midha, RPH

  • Pharmacist
  • Galveston, TX
  • NPI 1487958849
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1174065643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 23RD ST",
            "address_2": "SUITE F",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "77550",
            "telephone_number": "409-877-7029",
            "fax_number": "281-549-5957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 23RD ST",
            "address_2": "SUITE F",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "77550",
            "telephone_number": "409-877-7029",
            "fax_number": "281-549-5957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIESTA LIFECARE PHARMACY 3 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-15",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A",
        "authorized_official_last_name": "KALIDINDI",
        "authorized_official_first_name": "PREM",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "917-769-8014"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "31265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150052",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2164062",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14594",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Galveston Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katherine Suzanne Ferry, MD
• Kathleen Ferry, NP
• Alyssa Fick, DPT, PT
• Brittany Ann Fickau, MD
• Ricshonda Nicole Fielder
• Fifth Direction
• Eloiza Figueroa, FNP-C
• Juan Francisco Figueroa, MD
• Ryan Findlay, DO
• Patricia Elizabeth Fingerhut, OT

• All providers in Galveston, TX
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.