Provider Demographics
NPI:1659432987
Name:PORET'S THRIFTY WAY PHARMACY, INC,
Entity Type:Organization
Organization Name:PORET'S THRIFTY WAY PHARMACY, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:PORET
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:318-876-2104
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-0127
Mailing Address - Country:US
Mailing Address - Phone:318-876-2104
Mailing Address - Fax:318-876-3964
Practice Address - Street 1:1007 SYCAMORE ST
Practice Address - Street 2:SUITE A
Practice Address - City:COTTONPORT
Practice Address - State:LA
Practice Address - Zip Code:71327-3403
Practice Address - Country:US
Practice Address - Phone:318-876-2104
Practice Address - Fax:318-876-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA109863336C0003X, 332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1902736OtherNCPDP
LA1235512Medicaid
LA4693360001Medicare NSC