Provider Demographics
NPI:1164481255
Name:KENS THRIFTY WAY PHARMACY AND HOME MEDICAL INC
Entity Type:Organization
Organization Name:KENS THRIFTY WAY PHARMACY AND HOME MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-942-7551
Mailing Address - Street 1:333 HEYMANN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2415
Mailing Address - Country:US
Mailing Address - Phone:337-266-4621
Mailing Address - Fax:337-266-5596
Practice Address - Street 1:333 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2415
Practice Address - Country:US
Practice Address - Phone:337-266-4621
Practice Address - Fax:337-266-5596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENS THRIFTY WAY PHARMACY AND HOME MEDICAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-20
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1233692Medicaid
LA1932739OtherNCPDP PROVIDER IDENTIFICATION NUMBER
LA1932739OtherNCPDP PROVIDER IDENTIFICATION NUMBER