Provider Demographics
NPI:1700422094
Name:HANSABA LLC
Entity Type:Organization
Organization Name:HANSABA LLC
Other - Org Name:SACHSE DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:URVI
Authorized Official - Middle Name:CHIRAG
Authorized Official - Last Name:SOMPURA
Authorized Official - Suffix:
Authorized Official - Credentials:P
Authorized Official - Phone:469-443-0424
Mailing Address - Street 1:5624 HIGHWAY 78
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-3744
Mailing Address - Country:US
Mailing Address - Phone:469-443-0424
Mailing Address - Fax:
Practice Address - Street 1:5624 HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-3744
Practice Address - Country:US
Practice Address - Phone:469-443-0424
Practice Address - Fax:469-443-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150173Medicaid