Healthcare Provider Details

I. General information

NPI: 1346322575
Provider Name (Legal Business Name): EXPRESS SCRIPTS SPECIALTY DIST SVCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 N HANLEY RD STE B
SAINT LOUIS MO
63134-2715
US

IV. Provider business mailing address

21162 NETWORK PL
CHICAGO IL
60673-1238
US

V. Phone/Fax

Practice location:
  • Phone: 314-587-4050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number2000168119
License Number StateMO

VIII. Authorized Official

Name: MRS. SUSAN PEPPERS
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 513-858-4916