Lifecare Pharmacy Medical Drive

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

31269 Issued in TX

Legal business name

LIFECARE PHARMACY MEDICAL DRIVE

Practice address

4458 Medical Dr Ste 115
San Antonio, TX 78229-3700

Phone

(214) 351-0007

Fax

(214) 351-1750

NPI assigned

Oct 27, 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 1 LLC Doing business as

Locations

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1669924569",
    "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": "4458 MEDICAL DR STE 115",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293700",
            "telephone_number": "214-351-0007",
            "fax_number": "214-351-1750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECARE PHARMACY MEDICAL DRIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-27",
        "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": "31269",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149592",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2164571",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fiesta Lifecare Pharmacy 1 LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fiesta Lifecare Pharmacy 1 LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in San Antonio, TX
• Providers in San Antonio, 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.