Provider Demographics
NPI:1073534533
Name:GLENN'S FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:GLENN'S FAMILY PHARMACY INC
Other - Org Name:DBA WASHINGTON THRIF-T-WAY PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT-PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:SEBASTIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-826-3677
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70589-0446
Mailing Address - Country:US
Mailing Address - Phone:337-826-3677
Mailing Address - Fax:337-826-5070
Practice Address - Street 1:310 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:LA
Practice Address - Zip Code:70589-0446
Practice Address - Country:US
Practice Address - Phone:337-826-3677
Practice Address - Fax:337-826-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1191IR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1242896Medicaid
LA1242896Medicaid