Healthcare Provider Details

I. General information

NPI: 1780710426
Provider Name (Legal Business Name): THRIFT-TOWN HEALTHMART, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/07/2023
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 N 2ND ST
AMITE LA
70422
US

IV. Provider business mailing address

PO BOX 918
AMITE LA
70422
US

V. Phone/Fax

Practice location:
  • Phone: 985-748-8191
  • Fax: 985-748-5766
Mailing address:
  • Phone: 985-748-8191
  • Fax: 985-748-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6164IR
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number6164IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number6164IR
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number6164IR
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number6164 IR
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number6164IR
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number6164
License Number StateLA

VIII. Authorized Official

Name: EVANS RAY GLASGOW JR.
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 985-748-8191