Provider Demographics
NPI:1821159906
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:COO-OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FETCENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-553-1301
Mailing Address - Street 1:6330 WEST LOOP SOUTH
Mailing Address - Street 2:STE 700
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2928
Mailing Address - Country:US
Mailing Address - Phone:713-660-8888
Mailing Address - Fax:713-661-4828
Practice Address - Street 1:6330 WEST LOOP SOUTH
Practice Address - Street 2:STE 700 D
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2928
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:2006-12-13
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy