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General NPI Number Information
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NPI Number | 1073382958
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Entity Type | Organization
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Legal Business Name | SUNDANCE APOTHECARY, LP
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 201 COMMERCE ST STE 201
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City | FORT WORTH
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State | TX
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Zip | 76102-7206
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Country | US
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Telephone | 682-285-1100
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Fax | 682-285-1103
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Provider Business Mailing Address
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Address Line | PO BOX 2735
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City | FRISCO
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State | TX
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Zip | 75034-0051
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | RAJ MILAN CHHADUA
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Credential |
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Telephone | 682-285-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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