MEDICARE: THRIFTY PHARMACY, 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	332B00000X	Durable Medical Equipment & Medical Supplies	MG0460	KY

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

General Provider Information

NPI Number	:	1972569937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIFTY PHARMACY, INC

Provider Business Mailing Address
First Line	:	127 E MAIN ST
Second Line	:
City	:	PROVIDENCE
State	:	KY
Zip	:	42450-1268
Country	:	US
Telephone Number	:	270-667-2294
Fax Number	:	270-667-7230

Provider Business Practice Location Address
First Line	:	127 E MAIN ST
Second Line	:
City	:	PROVIDENCE
State	:	KY
Zip	:	42450-1268
Country	:	US
Telephone Number	:	270-667-2295
Fax Number	:	270-667-7230

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS P. GLOVER
Credential	:
Telephone Number	:	270-667-2295

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	06/08/2015

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