Healthcare Provider Details

I. General information

NPI: 1821159906
Provider Name (Legal Business Name): HDK ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 WEST LOOP SOUTH STE 700 D
BELLAIRE TX
77401-2928
US

IV. Provider business mailing address

6330 WEST LOOP SOUTH STE 700
BELLAIRE TX
77401-2928
US

V. Phone/Fax

Practice location:
  • Phone: 713-660-8888
  • Fax: 713-661-4828
Mailing address:
  • Phone: 713-660-8888
  • Fax: 713-661-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number25057
License Number StateTX

VIII. Authorized Official

Name: MARK FETCENKO
Title or Position: COO-OFFICER
Credential:
Phone: 832-553-1301