Healthcare Provider Details

I. General information

NPI: 1821014671
Provider Name (Legal Business Name): THRIFT CITY FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HIGHWAY 165 S
OAKDALE LA
71463-2846
US

IV. Provider business mailing address

201 HIGHWAY 165 S
OAKDALE LA
71463-2846
US

V. Phone/Fax

Practice location:
  • Phone: 318-335-1234
  • Fax: 318-335-3749
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number108-IR
License Number StateLA

VIII. Authorized Official

Name: JOHN P BERZAS
Title or Position: VICE PRESIDENT
Credential: PD
Phone: 318-335-1234