Provider Demographics
NPI:1780710426
Name:THRIFT-TOWN HEALTHMART, LLC
Entity type:Organization
Organization Name:THRIFT-TOWN HEALTHMART, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GLASGOW
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:985-748-8191
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422
Mailing Address - Country:US
Mailing Address - Phone:985-748-8191
Mailing Address - Fax:985-748-5766
Practice Address - Street 1:512 N 2ND ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422
Practice Address - Country:US
Practice Address - Phone:985-748-8191
Practice Address - Fax:985-748-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6164IR332BC3200X, 332BP3500X, 332BX2000X, 3336H0001X, 332B00000X
LA6164 IR333600000X
LA61643336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1903459OtherNCPDP
LA6164-IROtherLA PHARMACY PERMIT
LA1235245Medicaid
LA1235245Medicaid
LA=========0OtherBC BS LA DME
LA=========0OtherBC BS LA DME