Provider Demographics
NPI:1518297514
Name:EXPRESS PHARMACY LLC
Entity Type:Organization
Organization Name:EXPRESS PHARMACY LLC
Other - Org Name:EXPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-362-1120
Mailing Address - Street 1:PO BOX 6439
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35161-6439
Mailing Address - Country:US
Mailing Address - Phone:256-322-1056
Mailing Address - Fax:
Practice Address - Street 1:320 BATTLE ST W
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2431
Practice Address - Country:US
Practice Address - Phone:256-362-1120
Practice Address - Fax:256-761-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1133363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2123502OtherPK