Provider Demographics
NPI:1538330063
Name:HOUCHENS EXPRESS PHARMACY LLC
Entity Type:Organization
Organization Name:HOUCHENS EXPRESS PHARMACY LLC
Other - Org Name:SHELDON'S EXPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
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:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4914
Mailing Address - Country:US
Mailing Address - Phone:270-842-4515
Mailing Address - Fax:270-842-7254
Practice Address - Street 1:760 CAMPBELL LN
Practice Address - Street 2:STE 121
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1085
Practice Address - Country:US
Practice Address - Phone:270-782-6337
Practice Address - Fax:270-783-4272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
KYP073323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100083010Medicaid
2119602OtherPK
KYFH1310806OtherDEA
KYP07332OtherPHARMACY LICENSE
KY6198680002Medicare NSC