| NPI | 1669924569 |
|---|---|
| Doing Business As | FIESTA LIFECARE PHARMACY 1 LLC |
| Entity Type | Organization |
| Authorized Contact | PREM KALIDINDI Board Member 917-769-8014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: TX 31269) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2018-07-19 |