1740394899 NPI number — BOYER'S THRIFT PHARMACY INC.

Table of content: (NPI 1740394899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740394899 NPI number — BOYER'S THRIFT PHARMACY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOYER'S THRIFT PHARMACY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740394899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREAUX BRIDGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70517-0568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-228-2064
Provider Business Mailing Address Fax Number:
337-228-2194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1423 HENDERSON HWY.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70517-0568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-228-2064
Provider Business Practice Location Address Fax Number:
337-228-2194
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUGAS
Authorized Official First Name:
MAXWELL
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
337-228-2064

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  1489 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1251488 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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