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General NPI Number Information
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NPI Number | 1326278656
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Entity Type | Organization
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Legal Business Name | SHREE SIDDHIVINAYAK ENTERPRISE INC
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 6301 RICHMOND AVE STE 103
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City | HOUSTON
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State | TX
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Zip | 77057-5905
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Country | US
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Telephone | 346-357-3482
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Fax | 832-201-6727
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Provider Business Mailing Address
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Address Line | 6301 RICHMOND AVE STE 103
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City | HOUSTON
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State | TX
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Zip | 77057-5905
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Country | US
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Telephone | 346-357-3482
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Fax | 832-201-6727
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MR. ISSAM S KHEIRBECK
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Credential |
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Telephone | 817-304-2673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26554
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License Number State | TX
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