Provider Demographics
NPI:1225510795
Name:SUNDANCE APOTHECARY, LP
Entity Type:Organization
Organization Name:SUNDANCE APOTHECARY, LP
Other - Org Name:RENUE RX #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:MILAN
Authorized Official - Last Name:CHHADUA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:214-422-2598
Mailing Address - Street 1:PO BOX 2735
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-7206
Practice Address - Country:US
Practice Address - Phone:682-285-1100
Practice Address - Fax:682-285-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care