=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821159906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HDK ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 07/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6330 WEST LOOP SOUTH STE 700 D
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-660-8888
-----------------------------------------------------
Fax | 713-661-4828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6330 WEST LOOP SOUTH STE 700
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-660-8888
-----------------------------------------------------
Fax | 713-661-4828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO-OFFICER
-----------------------------------------------------
Name | MARK FETCENKO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-553-1301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 25057
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------