Provider Demographics
NPI:1497740245
Name:POINTE COUPEE THRIF T WAY PHY
Entity Type:Organization
Organization Name:POINTE COUPEE THRIF T WAY PHY
Other - Org Name:LIVONIA THRIF T WAY PHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:NED
Authorized Official - Last Name:FOTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:225-637-2811
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:LA
Mailing Address - Zip Code:70755-0187
Mailing Address - Country:US
Mailing Address - Phone:225-637-2811
Mailing Address - Fax:225-637-2811
Practice Address - Street 1:3066 LA HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:LA
Practice Address - Zip Code:70755-3601
Practice Address - Country:US
Practice Address - Phone:225-637-2356
Practice Address - Fax:225-637-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA696333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1226777Medicaid
LA1922257OtherNABP
LA1226777Medicaid
1049850001Medicare ID - Type Unspecified