Healthcare Provider Details

I. General information

NPI: 1164481255
Provider Name (Legal Business Name): KENS THRIFTY WAY PHARMACY AND HOME MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 HEYMANN BLVD
LAFAYETTE LA
70503-2415
US

IV. Provider business mailing address

333 HEYMANN BLVD
LAFAYETTE LA
70503-2415
US

V. Phone/Fax

Practice location:
  • Phone: 337-266-4621
  • Fax: 337-266-5596
Mailing address:
  • Phone: 337-266-4621
  • Fax: 337-266-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5617
License Number StateLA

VIII. Authorized Official

Name: MRS. TAMMY S ROBERT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 337-942-7551