Crystal City Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

31441 Issued in TX

Legal business name

CRYSTAL CITY PHARMACY LLC

Doing business as

Crystal City Pharmacy, LLC

Practice address

1313 Veterans Ave Ste I
Crystal City, TX 78839-1651

Phone

(830) 255-2201

Fax

(830) 448-2020

NPI assigned

Aug 14, 2017

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

• Crystal City Pharmacy, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

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

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

{
    "created_epoch": "1502668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766016000000",
    "number": "1548786395",
    "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": "78212",
            "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": "1313 VETERANS AVE STE I",
            "city": "CRYSTAL CITY",
            "state": "TX",
            "postal_code": "788391651",
            "telephone_number": "830-255-2201",
            "fax_number": "830-448-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CITY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-14",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "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": "31441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2170975",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149678",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal City Pharmacy, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Children's Clinic of Dimmit and Zavala, P.a.
• Childrens Clinic of Dimmit and Zavala PA
• Crystal City EMS
• Crystal City Independent School Distritct
• Crystal City Isd
• Crystal Dental Care PLLC
• Crystal Drug LP (Lifechek)
• Jennifer Dargis, PHARMD
• Roger Dehoyos, APRN
• Dimmit Regional Hospital

• Community/Retail Pharmacy in Crystal City, TX
• Providers in Crystal City, 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 Dec 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.