# GDR, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Haire Drug Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013053842
- **Authorized official:** GLENN DANIEL ROBERTS RPH (PRESIDENT)
- **Authorized official phone:** (662) 235-4422

## Contact information

- **Practice address:** 112 MERCER STREET, TCHULA, MS 39169
- **Practice address phone:** (662) 235-4422
- **Practice address fax:** (662) 235-4301
- **Mailing address:** PO BOX 217, TCHULA, MS 39169-0217
- **Mailing address phone:** (662) 235-4422
- **Mailing address fax:** (662) 235-4301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 01455 | MS | Yes |

## Other

- **Enumeration date:** 01/29/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00330361 | — | MS |