Provider Demographics
NPI:1730224783
Name:GERLANDS REALTY INC
Entity type:Organization
Organization Name:GERLANDS REALTY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-426-3581
Mailing Address - Street 1:302 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77562-2842
Mailing Address - Country:US
Mailing Address - Phone:281-426-3581
Mailing Address - Fax:281-426-7054
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:TX
Practice Address - Zip Code:77562-2842
Practice Address - Country:US
Practice Address - Phone:281-426-3581
Practice Address - Fax:281-426-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ0067741OtherDPS CONTROL SUBSTANCE #
TX4575998OtherNCPDP #
TX462993Medicaid
TX462993Medicaid