Healthcare Provider Details

I. General information

NPI: 1497740245
Provider Name (Legal Business Name): POINTE COUPEE THRIF T WAY PHY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 LA HIGHWAY 78
LIVONIA LA
70755-3601
US

IV. Provider business mailing address

PO BOX 187
LIVONIA LA
70755-0187
US

V. Phone/Fax

Practice location:
  • Phone: 225-637-2356
  • Fax: 225-637-2855
Mailing address:
  • Phone: 225-637-2811
  • Fax: 225-637-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number696
License Number StateLA

VIII. Authorized Official

Name: MR. FRANK NED FOTI
Title or Position: OWNER PRESIDENT
Credential: RPH
Phone: 225-637-2811