Provider Demographics
NPI:1306031760
Name:THRIFTY WAY PHARMACY OF ST. MARTINVILLE
Entity Type:Organization
Organization Name:THRIFTY WAY PHARMACY OF ST. MARTINVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DARCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-394-9772
Mailing Address - Street 1:1620 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-4310
Mailing Address - Country:US
Mailing Address - Phone:337-394-9772
Mailing Address - Fax:337-394-9773
Practice Address - Street 1:1620 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-4310
Practice Address - Country:US
Practice Address - Phone:337-394-9772
Practice Address - Fax:337-394-9773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1801463-0013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1234915Medicaid
LA6215220001Medicare NSC