Fiesta Lifecare Pharmacy 5 LLC
NPI 1104377332 · Community/Retail Pharmacy · Dallas, TX
Enrolled with Medicare as Part B Supplier - Pharmacy · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Fiesta Lifecare Pharmacy 5 LLC is a Community/Retail Pharmacy organization in Dallas, TX (NPI 1104377332).
Provider details
- NPI number
- 1104377332
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Sirisha Kandi, Pharmacist Owner(972) 357-4477
Specialties & taxonomies
Suppliers
- Pharmacy333600000X
Suppliers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
9 yrs in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
13 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| Admn Sarscov2 Vacc 1 Dose90480 | 13 | $43 |
Typical Medicare-allowed amounts for these services range $43–$43 (2024). The Medicare-allowed amount is what Medicare recognizes for a service under fee-for-service — a reference figure for 2024, not a price quote and not what you would be billed. Medicare Part B covers roughly an eighth of all NPIs (65+ skew); services with fewer than 11 beneficiaries are suppressed by CMS. Source: CMS Medicare Physician & Other Practitioners, by Provider & Service.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Fiesta Lifecare Pharmacy 5 LLC
- Doing business as
- Fiesta Lifecare Pharmacy 5 LLC
- Doing business as
- Fiesta Mlk Pharmacy
Registry dates
- Enumerated
- 2016-10-24
- Last updated
- 2020-07-30
- Certified
- 2020-07-30
Frequently asked questions
- What is Fiesta Lifecare Pharmacy 5 LLC's NPI number?
- Fiesta Lifecare Pharmacy 5 LLC's National Provider Identifier (NPI) is 1104377332, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Fiesta Lifecare Pharmacy 5 LLC?
- Fiesta Lifecare Pharmacy 5 LLC is classified in the NPPES registry as Community/Retail Pharmacy (Suppliers).
- Where is Fiesta Lifecare Pharmacy 5 LLC located?
- Fiesta Lifecare Pharmacy 5 LLC's practice location on file with NPPES is 3230 Martin Luther King Jr Blvd, Dallas, TX 75210-2417.
- What is Fiesta Lifecare Pharmacy 5 LLC's phone number?
- The practice phone number listed in the NPPES registry for Fiesta Lifecare Pharmacy 5 LLC is (214) 421-1067.
- Does Fiesta Lifecare Pharmacy 5 LLC accept Medicare?
- Fiesta Lifecare Pharmacy 5 LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Fiesta Lifecare Pharmacy 5 LLC?
- The authorized official listed on Fiesta Lifecare Pharmacy 5 LLC's NPPES record is Sirisha Kandi, Pharmacist Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Fiesta Lifecare Pharmacy 5 LLC's NPI active?
- Yes — Fiesta Lifecare Pharmacy 5 LLC's NPI (1104377332) is active in the NPPES registry as of the last update on 2020-07-30.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.