Healthcare Provider Details

I. General information

NPI: 1578317913
Provider Name (Legal Business Name): KEN'S THRIFTY WAY PHARMACY AND HOME MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 E PRUDHOMME ST
OPELOUSAS LA
70570-6499
US

IV. Provider business mailing address

PO BOX 1325
OPELOUSAS LA
70571-1325
US

V. Phone/Fax

Practice location:
  • Phone: 337-942-7551
  • Fax:
Mailing address:
  • Phone: 337-942-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TONYA L ROBERIE
Title or Position: CREDENTIALING
Credential:
Phone: 337-942-8911