Organization · Type 2 NPI

Wycliff Pharmacy

Community/Retail Pharmacy · Dallas, TX

NPI number 1265974737 Active

Practice location

4309 Lemmon Ave
Dallas, TX 75219-2706

Call (972) 227-2126 Map

Fax (972) 227-1678

Mailing address

PO Box 12929
San Antonio, TX 78212-0929

Specialties and licenses

Taxonomy	Code	License
Pharmacy	333600000X	None listed
Community/Retail Pharmacy Primary	3336C0003X	31268 (TX)

Community/Retail Pharmacy: A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other …

3 other providers at this address

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NPI record

NPI: 1265974737
Entity type: Organization (Type 2)
Issued: Nov 15, 2016
Last updated: Sep 19, 2025
Status: Active

Other names

<unavail>
Fiesta Lifecare Pharmacy 6, LLC · doing business as
Fiesta Lifecare Pharmacy 6, LLC · doing business as

Authorized official

Prem Kalidindi
Board Member
(917) 769-8014

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1265974737

Wycliff Pharmacy's National Provider Identifier is 1265974737, issued on Nov 15, 2016. The primary taxonomy on file is Community/Retail Pharmacy (3336C0003X), and the practice location is in Dallas, TX. The record was last updated on Sep 19, 2025.