Provider Demographics
NPI:1326278656
Name:SHREE SIDDHIVINAYAK ENTERPRISE INC
Entity Type:Organization
Organization Name:SHREE SIDDHIVINAYAK ENTERPRISE INC
Other - Org Name:HULEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ISSAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHEIRBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-304-2673
Mailing Address - Street 1:6301 RICHMOND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5905
Mailing Address - Country:US
Mailing Address - Phone:346-357-3482
Mailing Address - Fax:832-201-6727
Practice Address - Street 1:6301 RICHMOND AVE STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5905
Practice Address - Country:US
Practice Address - Phone:346-357-3482
Practice Address - Fax:832-201-6727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265543336C0003X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146040Medicaid
2121145OtherPK