Healthcare Provider Details

I. General information

NPI: 1083029540
Provider Name (Legal Business Name): EXPRESS SCRIPTS SPECIALTY DISTRIBUTION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 NORTH HANLEY ROAD SUITE A
ST. LOUIS MO
63134
US

IV. Provider business mailing address

4700 NORTH HANLEY ROAD SUITE A
ST. LOUIS MO
63134
US

V. Phone/Fax

Practice location:
  • Phone: 800-332-5455
  • Fax: 877-304-9042
Mailing address:
  • Phone: 800-332-5455
  • Fax: 877-304-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number2011036221
License Number StateMO

VIII. Authorized Official

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