Healthcare Provider Details

I. General information

NPI: 1942307780
Provider Name (Legal Business Name): THRIFTY WAY OF LAKE CHARLES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 3RD AVENUE
LAKE CHARLES LA
70601
US

IV. Provider business mailing address

1001 3RD AVENUE
LAKE CHARLES LA
70601
US

V. Phone/Fax

Practice location:
  • Phone: 337-433-1429
  • Fax: 337-433-9971
Mailing address:
  • Phone: 337-433-1429
  • Fax: 337-433-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number006031
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6031IR
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNY T. NASH
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 337-433-1429