Glenn Daniel Roberts, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

E-07015 Issued in MS

Practice address

112 Mercer St
Tchula, MS 39169

Phone

(662) 235-4422

NPI assigned

Mar 15, 2007

Last updated

May 30, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• GDR, Inc

  dba Haire Drug Center

  • Community/Retail Pharmacy
  • Tchula, MS
  • NPI 1013053842
  NPD (past) Authorized official

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496102400000",
    "number": "1891829677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 217",
            "city": "TCHULA",
            "state": "MS",
            "postal_code": "391690217",
            "telephone_number": "662-235-4422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MERCER ST",
            "city": "TCHULA",
            "state": "MS",
            "postal_code": "39169",
            "telephone_number": "662-235-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "GLENN",
        "middle_name": "DANIEL",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2017-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E-07015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele Latonya Brooks, FNP-C
• GDR, Inc (Haire Drug Center)
• Heaven Sent Foot Healthcare, PLCC
• Nikita Hogan
• Mallory Community Health (Dr. Arenia C. Mallory Community Health Center, Inc.)
• Thomas Ross
• Candice Smith, LCSW
• The Myers Foundation Christian Family Health Centers
• Thomas Ross (Southwest Rehabilitation Services)
• Dealice Nikita Young, RN

• Pharmacist in Tchula, MS
• Providers in Tchula, MS by specialty
• Pharmacist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2017; 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.