Provider Demographics
NPI:1083029540
Name:EXPRESS SCRIPTS SPECIALTY DISTRIBUTION SERVICES, INC.
Entity Type:Organization
Organization Name:EXPRESS SCRIPTS SPECIALTY DISTRIBUTION SERVICES, INC.
Other - Org Name:EXPRESS SCRIPTS SPECIALTY DISTRIBUTION SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-858-4916
Mailing Address - Street 1:4700 NORTH HANLEY ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63134
Mailing Address - Country:US
Mailing Address - Phone:800-332-5455
Mailing Address - Fax:877-304-9042
Practice Address - Street 1:4700 NORTH HANLEY ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134
Practice Address - Country:US
Practice Address - Phone:800-332-5455
Practice Address - Fax:877-304-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
MO20110362213336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146320OtherPK