Provider Demographics
NPI:1942307780
Name:THRIFTY WAY OF LAKE CHARLES, INC
Entity Type:Organization
Organization Name:THRIFTY WAY OF LAKE CHARLES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:T
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:337-433-1429
Mailing Address - Street 1:1001 3RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-433-1429
Mailing Address - Fax:337-433-9971
Practice Address - Street 1:1001 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-433-1429
Practice Address - Fax:337-433-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006031333600000X
LA6031IR3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1906924OtherNCPDP PROVIDER IDENTIFICATION NUMBER
LA1234567Medicaid
6260830001Medicare NSC
1060440001Medicare NSC