Provider Demographics
NPI:1336547579
Name:HOUCHENS EXPRESS PHARMACY LLC
Entity Type:Organization
Organization Name:HOUCHENS EXPRESS PHARMACY LLC
Other - Org Name:SHELDON'S EXPRESS PHARMACY #5
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHELDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-392-0821
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:270-715-0650
Mailing Address - Fax:270-715-0655
Practice Address - Street 1:5575 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104
Practice Address - Country:US
Practice Address - Phone:270-715-0650
Practice Address - Fax:270-715-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYP076613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100335780Medicaid
KYK189870OtherMEDICARE FLU
KY1834692OtherNCPDP
KYP07661OtherPHARMACY PERMIT
KYP07661OtherPHARMACY PERMIT
KY6198680007Medicare NSC