Provider Demographics
NPI:1447386859
Name:GERLANDS REALTY INC
Entity Type:Organization
Organization Name:GERLANDS REALTY INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-689-3446
Mailing Address - Street 1:20851 FM 1485 RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-7329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20851 FM 1485 RD
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-7329
Practice Address - Country:US
Practice Address - Phone:281-689-3446
Practice Address - Fax:281-689-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22005333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX465507Medicaid
4523204OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TXBT8066804OtherDEA #