MEDICARE: SHREE SIDDHIVINAYAK ENTERPRISE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	26554	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2121145	OTHER		PK

General Provider Information

NPI Number	:	1326278656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHREE SIDDHIVINAYAK ENTERPRISE INC

Provider Business Mailing Address
First Line	:	6301 RICHMOND AVE STE 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5905
Country	:	US
Telephone Number	:	346-357-3482
Fax Number	:	832-201-6727

Provider Business Practice Location Address
First Line	:	6301 RICHMOND AVE STE 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-5905
Country	:	US
Telephone Number	:	346-357-3482
Fax Number	:	832-201-6727

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MR. ISSAM S KHEIRBECK
Credential	:
Telephone Number	:	817-304-2673

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	06/10/2022

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