Provider Demographics
NPI:1649200932
Name:HDK ENTERPRISES LLC
Entity Type:Organization
Organization Name:HDK ENTERPRISES LLC
Other - Org Name:SOUTHSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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 1:7700 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4406
Mailing Address - Country:US
Mailing Address - Phone:713-660-8888
Mailing Address - Fax:713-661-4828
Practice Address - Street 1:7700 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4406
Practice Address - Country:US
Practice Address - Phone:713-660-8888
Practice Address - Fax:713-661-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0828790001Medicare NSC