Organization
GCR INC
Active
Other names
SNYDERS DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
JASON AMDAHL (OWNER)
(218) 643-3871
Entity
Organization
Contact information
Practice address
126 5TH ST N, BRECKENRIDGE, MN 56520-1421
(218) 643-3871
(218) 643-1459
Mailing address
PO BOX 251, BRECKENRIDGE, MN 56520-0251
(218) 643-3871
(218) 643-1459
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
260558
MN
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21024
—
ND
01
—
2418754
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
8534000
—
SD
05
—
935060800
—
MN
Enumeration date
08/10/2006
Last updated
01/28/2010
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