1154420271 NPI number — HOUCHENS EXPRESS PHARMACY LLC

Table of content: (NPI 1154420271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154420271 NPI number — HOUCHENS EXPRESS PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUCHENS EXPRESS PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHELDON'S EXPRESS PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154420271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-586-4471
Provider Business Mailing Address Fax Number:
270-586-8595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-586-4471
Provider Business Practice Location Address Fax Number:
270-586-8595
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHELDON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
270-392-0821

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  P07369 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: P00469 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P07369 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X , with the licence number: P07369 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1804726 . This is a "NCPDP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100218100 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P07369 . This is a "PHARMACY PERMIT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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