Provider Demographics
NPI:1336450154
Name:HOUCHENS EXPRESS PHARMACY LLC
Entity Type:Organization
Organization Name:HOUCHENS EXPRESS PHARMACY LLC
Other - Org Name:SHELDON'S EXPRESS PHARMACY #6
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OPERATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-901-3431
Mailing Address - Street 1:1810 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9387
Mailing Address - Country:US
Mailing Address - Phone:812-683-9600
Mailing Address - Fax:812-683-2972
Practice Address - Street 1:1810 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9387
Practice Address - Country:US
Practice Address - Phone:812-683-9600
Practice Address - Fax:812-683-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IN60006227A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ2030OtherMEDICARE B FLU
IN20100090AMedicaid
ININ2030OtherMEDICARE B FLU