Provider Demographics
NPI:1720539752
Name:EXPRESS MEDICAL PHARMACY LLC
Entity Type:Organization
Organization Name:EXPRESS MEDICAL PHARMACY LLC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALHALABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-973-3879
Mailing Address - Street 1:1010 DEVONWORTH MANOR WAY
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8548
Mailing Address - Country:US
Mailing Address - Phone:618-973-3879
Mailing Address - Fax:
Practice Address - Street 1:1 ROYAL HEIGHTS CTR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5705
Practice Address - Country:US
Practice Address - Phone:800-633-4227
Practice Address - Fax:618-641-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336M0002X
MO20180055863336C0003X
IL0540194163336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164622OtherPK
IL3489444326222601Medicaid