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Contact Information

GDR, INC
112 MERCER STREET
TCHULA, MS39169
 Phone: 662-235-4422
 Fax: 662-235-4301
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for GDR, INC

NPI Number 1013053842
LBN Legal business name GDR, INC
Authorized official GLENN ROBERTS - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 01/29/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers
MS License # 01455
MS Medicaid 00330361
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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