Fiesta Lifecare Pharmacy 4 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

31266 Issued in TX

Legal business name

FIESTA LIFECARE PHARMACY 4 LLC

Doing business as

Fiesta Lifecare Pharmacy 4, LLC

Practice address

4202 Pioneer Rd
Balch Springs, TX 75180-3537

Phone

(972) 557-3535

Fax

(972) 557-4187

NPI assigned

Nov 15, 2016

Last updated

Sep 19, 2025By the provider in NPPES

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

Board Member

Phone

(917) 769-8014

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Fiesta Lifecare Pharmacy 4, LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Prem S. Kalidindi

  • Pharmacist
  • Irving, TX
  • NPI 1699102699
  Authorized official Same address or phone

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": "1356883821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631670",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "75063",
            "telephone_number": "210-881-0890",
            "fax_number": "210-564-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 PIONEER RD",
            "city": "BALCH SPRINGS",
            "state": "TX",
            "postal_code": "751803537",
            "telephone_number": "972-557-3535",
            "fax_number": "972-557-4187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIESTA LIFECARE PHARMACY 4 LLC",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "31266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149595",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2164063",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fiesta Lifecare Pharmacy 4, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Balch Springs, TX
• Providers in Balch Springs, 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.