Provider Demographics
NPI:1346234077
Name:EXPRESS PHARMACY INC
Entity Type:Organization
Organization Name:EXPRESS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-753-3634
Mailing Address - Street 1:2800 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:ALMO
Mailing Address - State:KY
Mailing Address - Zip Code:42020-9436
Mailing Address - Country:US
Mailing Address - Phone:270-753-3634
Mailing Address - Fax:270-753-3652
Practice Address - Street 1:2800 RADIO RD
Practice Address - Street 2:
Practice Address - City:ALMO
Practice Address - State:KY
Practice Address - Zip Code:42020-9436
Practice Address - Country:US
Practice Address - Phone:270-753-3634
Practice Address - Fax:270-753-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06953333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5162850001Medicare NSC