Provider Demographics
NPI:1649352006
Name:ESI MAIL PHARMACY SERVICE INC
Entity type:Organization
Organization Name:ESI MAIL PHARMACY SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST. 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 1:7909 S HARDY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7909 S HARDY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1112
Practice Address - Country:US
Practice Address - Phone:800-955-1171
Practice Address - Fax:480-403-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY037083336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0327317OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AZ840399Medicaid