Wycliff Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

31268 Issued in TX

Legal business name

WYCLIFF PHARMACY

Practice address

4309 Lemmon Ave
Dallas, TX 75219-2706

Phone

(972) 227-2126

Fax

(972) 227-1678

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 Kalidindi

Title

Board Member

Phone

(917) 769-8014

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Fiesta Lifecare Pharmacy 6, LLC Doing business as

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

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1265974737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12929",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782120929",
            "telephone_number": "210-881-0890",
            "fax_number": "210-569-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 LEMMON AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752192706",
            "telephone_number": "972-227-2126",
            "fax_number": "972-227-1678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYCLIFF PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-15",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "KALIDINDI",
        "authorized_official_first_name": "PREM",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "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": "31268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149597",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2164698",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fiesta Lifecare Pharmacy 6, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fiesta Lifecare Pharmacy 6, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• J Robert Wyatt, MD
• Teresa Lynne Wyatt, LCDC
• Adam Thomas Wyble, PA-C
• Alexander Wyckoff, MD
• Myra Helen Wyckoff, MD
• Stefani Ann Wylie, PT
• Allison N Wyll, MD
• Michael Louis Wyman, M.D.
• Lindsey Wymer, PA-C
• Natasha L. Wyndham Hanners, M.D.

• Community/Retail Pharmacy in Dallas, TX
• Providers in Dallas, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; 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.