Provider Demographics
NPI:1710074919
Name:EXPRESS SCRIPTS PHARMACY INC
Entity Type:Organization
Organization Name:EXPRESS SCRIPTS PHARMACY INC
Other - Org Name:EXPRESS SCRIPTS
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 1:501 RONDA CT
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-4159
Mailing Address - Country:US
Mailing Address - Phone:724-765-3000
Mailing Address - Fax:724-765-3186
Practice Address - Street 1:501 RONDA CT
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-4159
Practice Address - Country:US
Practice Address - Phone:724-765-3000
Practice Address - Fax:724-765-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP414168L3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143933OtherPK