| NPI | 1104377332 |
|---|---|
| Doing Business As | FIESTA LIFECARE PHARMACY 5 LLC |
| Doing Business As | FIESTA MLK PHARMACY |
| Entity Type | Organization |
| Authorized Contact | SIRISHA KANDI Pharmacist Owner 972-357-4477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 31267) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2020-07-30 |