Provider Demographics
NPI:1154459352
Name:SINDHU ENTERPRISE INC
Entity Type:Organization
Organization Name:SINDHU ENTERPRISE INC
Other - Org Name:HERITAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RAMU
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-741-7100
Mailing Address - Street 1:3529 HERITAGE TRACE PKWY
Mailing Address - Street 2:STE 141
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4970
Mailing Address - Country:US
Mailing Address - Phone:817-741-7100
Mailing Address - Fax:817-741-7101
Practice Address - Street 1:3529 HERITAGE TRACE PKWY
Practice Address - Street 2:STE 141
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4970
Practice Address - Country:US
Practice Address - Phone:817-741-7100
Practice Address - Fax:817-741-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX254213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145771Medicaid
2100004OtherPK