Provider Demographics
NPI:1376576058
Name:MEDI-THRIFT DRUGS INC
Entity Type:Organization
Organization Name:MEDI-THRIFT DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTANZA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-744-5617
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:LA
Mailing Address - Zip Code:71340
Mailing Address - Country:US
Mailing Address - Phone:318-744-5617
Mailing Address - Fax:318-744-5368
Practice Address - Street 1:302 BUSHLEY ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:LA
Practice Address - Zip Code:71340
Practice Address - Country:US
Practice Address - Phone:318-744-5617
Practice Address - Fax:318-744-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
LA9412333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1228419Medicaid
0201890001Medicare NSC