Provider Demographics
NPI:1164887493
Name:HDK ENTERPRISES, LLC
Entity Type:Organization
Organization Name:HDK ENTERPRISES, LLC
Other - Org Name:SOUTHSIDE PHARMACY 4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-8888
Mailing Address - Street 1:300 S 2ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2702
Mailing Address - Country:US
Mailing Address - Phone:956-627-3259
Mailing Address - Fax:956-627-3117
Practice Address - Street 1:300 S 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2702
Practice Address - Country:US
Practice Address - Phone:956-627-3259
Practice Address - Fax:956-627-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30617OtherLICENSE
TX5917983OtherNCPDP