GDT LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

GDT LLC

Practice address

19500 Sandridge Way Ste 140
Leesburg, VA 20176-3689

Phone

(571) 440-2401

Fax

(571) 440-2405

NPI assigned

Dec 19, 2019

Organization subpart

No

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

Authorized official

Name

Tiffany Hall

Title

Administrator

Phone

(571) 440-2401

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Health Star Pharmacy Doing business as

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

{
    "created_epoch": "1576713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585267200000",
    "number": "1013555143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19500 SANDRIDGE WAY STE 140",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201763689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19500 SANDRIDGE WAY STE 140",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201763689",
            "telephone_number": "571-440-2401",
            "fax_number": "571-440-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GDT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-19",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "571-440-2401"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013555143",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Star Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Health Star Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Leesburg, VA
• Providers in Leesburg, VA by specialty
• Community/Retail Pharmacy in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.