Organization
GDR, INC
Active
Other names
Haire Drug Center
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN DANIEL ROBERTS RPH (PRESIDENT)
(662) 235-4422
Entity
Organization
Contact information
Practice address
112 MERCER STREET, TCHULA, MS 39169
(662) 235-4422
(662) 235-4301
Mailing address
PO BOX 217, TCHULA, MS 39169-0217
(662) 235-4422
(662) 235-4301
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
01455
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330361
—
MS
Enumeration date
01/29/2007
Last updated
08/22/2020
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