Provider Demographics
NPI:1285187369
Name:HOUCHENS EXPRESS PHARMACY, LLC
Entity Type:Organization
Organization Name:HOUCHENS EXPRESS PHARMACY, LLC
Other - Org Name:SHELDON'S SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-901-3431
Mailing Address - Street 1:843 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4914
Mailing Address - Country:US
Mailing Address - Phone:270-901-3431
Mailing Address - Fax:270-901-3422
Practice Address - Street 1:843 FAIRVIEW AVE
Practice Address - Street 2:SUITE 5B
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4914
Practice Address - Country:US
Practice Address - Phone:270-901-3431
Practice Address - Fax:270-901-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP077783336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP07778OtherPHARMACY LICENSE