Healthcare Provider Details

I. General information

NPI: 1285784058
Provider Name (Legal Business Name): HOUCHENS EXPRESS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/23/2024
Certification Date:
Deactivation Date: 08/21/2024
Reactivation Date: 08/23/2024

III. Provider practice location address

815 SYCAMORE ST
ROCKPORT IN
47635-1123
US

IV. Provider business mailing address

815 SYCAMORE ST
ROCKPORT IN
47635-1123
US

V. Phone/Fax

Practice location:
  • Phone: 812-649-2227
  • Fax: 812-649-3253
Mailing address:
  • Phone: 812-649-2227
  • Fax: 812-649-3253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60006377A
License Number StateIN

VIII. Authorized Official

Name: LESLIE BIDWELL
Title or Position: OPERATIONS COORDINATOR
Credential:
Phone: 812-661-8684