Provider Demographics
NPI:1457749590
Name:HDK ENTERPRISES LLC
Entity Type:Organization
Organization Name:HDK ENTERPRISES LLC
Other - Org Name:SOUTHSIDE PHARMACY 9
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:832-813-5296
Mailing Address - Street 1:7700 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4456
Mailing Address - Country:US
Mailing Address - Phone:713-660-8888
Mailing Address - Fax:713-661-4828
Practice Address - Street 1:1111 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 160
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3476
Practice Address - Country:US
Practice Address - Phone:832-813-5296
Practice Address - Fax:832-813-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29706OtherSTATE BOARD OF PHARMACY LICENSE