Provider Demographics
NPI:1144334129
Name:MAGNOLIA BUSINESS CO, INC. DBA 'THRIFTY WAY PHARMACY'
Entity type:Organization
Organization Name:MAGNOLIA BUSINESS CO, INC. DBA 'THRIFTY WAY PHARMACY'
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:(PIC) PHARMACY OWNER CORP-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:VERMILLION
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST (RPH)
Authorized Official - Phone:318-792-6231
Mailing Address - Street 1:1019 FERTITTA BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446
Mailing Address - Country:US
Mailing Address - Phone:337-239-3474
Mailing Address - Fax:337-238-2575
Practice Address - Street 1:1019 FERTITTA BLVD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446
Practice Address - Country:US
Practice Address - Phone:337-239-3474
Practice Address - Fax:337-238-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X, 3336C0004X, 333600000X
LA662IR3336C0003X
LA6291-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1226050Medicaid
LA2200402Medicaid
1917991OtherNCPDP #
1917991OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4481440001Medicare NSC