Provider Demographics
NPI:1427619865
Name:HOUCHENS EXPRESS PHARMACY LLC
Entity type:Organization
Organization Name:HOUCHENS EXPRESS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:270-901-3431
Mailing Address - Street 1:1325 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-2906
Mailing Address - Country:US
Mailing Address - Phone:618-263-9101
Mailing Address - Fax:
Practice Address - Street 1:1325 W 9TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-2906
Practice Address - Country:US
Practice Address - Phone:618-263-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL320.013069OtherILLINOIS CSR
1495541OtherNCPDP
IL054.021282OtherIL PHARMACY PERMIT
IL054.021282OtherIL PHARMACY PERMIT