Healthcare Provider Details

I. General information

NPI: 1164526778
Provider Name (Legal Business Name): THRIFTY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 WALLACE ST
PROVIDENCE KY
42450-1278
US

IV. Provider business mailing address

116 WALLACE ST
PROVIDENCE KY
42450-1278
US

V. Phone/Fax

Practice location:
  • Phone: 270-667-0940
  • Fax:
Mailing address:
  • Phone: 270-667-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG0460
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberMG0460
License Number StateKY

VIII. Authorized Official

Name: MR. THOMAS P GLOVER
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 270-667-0940