Provider Demographics
NPI:1255351607
Name:THRIFTY WAY PHARMACY OF ABBEVILLE, INC.
Entity type:Organization
Organization Name:THRIFTY WAY PHARMACY OF ABBEVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-893-6304
Mailing Address - Street 1:2640 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4043
Mailing Address - Country:US
Mailing Address - Phone:337-893-6304
Mailing Address - Fax:337-893-6306
Practice Address - Street 1:2640 NORTH DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4043
Practice Address - Country:US
Practice Address - Phone:337-893-6304
Practice Address - Fax:337-893-6306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THRIFTY WAY PHARMACY OF ABBEVILLE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1415-IR332B00000X, 332BC3200X, 332BP3500X, 333600000X, 3336C0003X, 3336H0001X, 3336L0003X, 3336M0002X, 3336S0011X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1217654Medicaid
7212435002OtherTRICARE HIT
LA0001OtherCHAMPUS/TRICARE
LA=========AOtherBCBS HIT
LA1217654Medicaid
LA=========0OtherBCBS DME
LA48341Medicare PIN