NPIMap

Organization Active NPI

Sundance Apothecary, LP

  • Community/Retail Pharmacy
  • Fort Worth, TX
National Provider Identifier
1225510795
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SUNDANCE APOTHECARY, LP
Practice address
201 Commerce St
Fort Worth, TX 76102-7206
Phone
(682) 285-1100
Fax
(682) 285-1103
NPI assigned
Aug 31, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Raj Milan Chhadua, PHARMDNPI 1316273956
Title
Owner
Phone
(214) 422-2598

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

201 Commerce St
Fort Worth, TX 76102-7206

Mailing address

PO Box 2735
Frisco, TX 75034-0051

Other names 1

  • ReNue RX #4 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200506000107 TX Part B Supplier - Pharmacy 0547593477 Practice locations: Fort Worth, TX
O20200715001640 TX Part B Supplier - Independent Clinical Laboratory 0547593477 Practice locations: Fort Worth, TX

National Provider Directory

National Provider Directory

Locations

201 Commerce St
#201
Fort Worth, TX 76102
Phone (682) 285-1100

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1225510795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2735",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750340051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 COMMERCE ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761027206",
            "telephone_number": "682-285-1100",
            "fax_number": "682-285-1103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE APOTHECARY, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-31",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A",
        "authorized_official_last_name": "CHHADUA",
        "authorized_official_first_name": "RAJ",
        "authorized_official_middle_name": "MILAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-422-2598",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ReNue RX #4",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.