Provider Demographics
NPI:1932276748
Name:MEDICINE EXPRESS, LLC
Entity Type:Organization
Organization Name:MEDICINE EXPRESS, LLC
Other - Org Name:MEDICINE EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:K
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:618-515-4035
Mailing Address - Street 1:7650 MAGNA DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3317
Mailing Address - Country:US
Mailing Address - Phone:618-515-4035
Mailing Address - Fax:618-416-7172
Practice Address - Street 1:7650 MAGNA DR STE 130
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3317
Practice Address - Country:US
Practice Address - Phone:618-515-4035
Practice Address - Fax:618-416-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
IL0540170603336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1477517OtherNCPDP
FM8300648OtherDEA
ILBM7437999OtherDEA
IL214541Medicare PIN
IL1263550001Medicare NSC