Provider Demographics
NPI:1205947298
Name:THRIFTY PHARMACY
Entity type:Organization
Organization Name:THRIFTY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-395-4505
Mailing Address - Street 1:226 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2114
Mailing Address - Country:US
Mailing Address - Phone:618-395-4505
Mailing Address - Fax:
Practice Address - Street 1:226 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2114
Practice Address - Country:US
Practice Address - Phone:618-395-4505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.00703332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL0732360003Medicare NSC
IL0732360003Medicare PIN