Provider Demographics
NPI:1033356944
Name:THRIFTY WAY OF LAKE CHARLES
Entity Type:Organization
Organization Name:THRIFTY WAY OF LAKE CHARLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:LANINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-433-1429
Mailing Address - Street 1:1001 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-4640
Mailing Address - Country:US
Mailing Address - Phone:337-433-1429
Mailing Address - Fax:337-433-9971
Practice Address - Street 1:1001 3RD AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-4640
Practice Address - Country:US
Practice Address - Phone:337-433-1429
Practice Address - Fax:337-433-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6031IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1234567Medicaid
1060440001Medicare NSC