Provider Demographics
NPI:1174659429
Name:MICHELLE ANDRUS THRIFTY WAY OF BASILE LLC
Entity Type:Organization
Organization Name:MICHELLE ANDRUS THRIFTY WAY OF BASILE LLC
Other - Org Name:THRIFTY WAY PHARMACY OF BASILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-432-6642
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:3131 STAGG
Mailing Address - City:BASILE
Mailing Address - State:LA
Mailing Address - Zip Code:70515-0472
Mailing Address - Country:US
Mailing Address - Phone:337-432-6642
Mailing Address - Fax:337-432-6606
Practice Address - Street 1:3131 STAGG
Practice Address - Street 2:
Practice Address - City:BASILE
Practice Address - State:LA
Practice Address - Zip Code:70515-0472
Practice Address - Country:US
Practice Address - Phone:337-432-6642
Practice Address - Fax:337-432-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3213IR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1262927Medicaid
LA1262927Medicaid