Provider Demographics
NPI:1558440719
Name:ALFRED RICHARD'S THRIF-T-WAY PHARMACY OF OPELOUSAS, INC
Entity Type:Organization
Organization Name:ALFRED RICHARD'S THRIF-T-WAY PHARMACY OF OPELOUSAS, INC
Other - Org Name:AL'S THRIFTY WAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:GANNON
Authorized Official - Middle Name:G
Authorized Official - Last Name:BROUILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-942-2653
Mailing Address - Street 1:1406 W LANDRY ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-2623
Mailing Address - Country:US
Mailing Address - Phone:337-942-2653
Mailing Address - Fax:337-942-8490
Practice Address - Street 1:1406 W LANDRY ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-2623
Practice Address - Country:US
Practice Address - Phone:337-942-2653
Practice Address - Fax:337-942-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.007302-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1241148Medicaid
LA1241148Medicaid