MEDICARE: THRIFTY PHARMACY NO III INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	14701	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2073580	OTHER		PK

General Provider Information

NPI Number	:	1225055007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIFTY PHARMACY NO III INC

Provider Business Mailing Address
First Line	:	10904 N MAY AVE STE L
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-6203
Country	:	US
Telephone Number	:	405-751-2852
Fax Number	:	405-755-2952

Provider Business Practice Location Address
First Line	:	10904 N MAY AVE STE L
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-6203
Country	:	US
Telephone Number	:	405-751-2852
Fax Number	:	405-755-2952

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	DANI COLSTON
Credential	:	DPH
Telephone Number	:	405-751-2852

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	09/19/2025

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