Provider Demographics
NPI:1851495451
Name:EXPRESS SAVE-ON DRUGS LLC
Entity type:Organization
Organization Name:EXPRESS SAVE-ON DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DHP
Authorized Official - Phone:731-668-7529
Mailing Address - Street 1:622 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-2241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:622 W MARKET ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-2241
Practice Address - Country:US
Practice Address - Phone:731-658-3973
Practice Address - Fax:731-658-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000000223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4439724OtherOTHER ID NUMBER
4439724OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4439724OtherOTHER ID NUMBER