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General NPI Number Information
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NPI Number | 1467534826
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Entity Type | Organization
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Legal Business Name | EXPRESS SCRIPTS SPECIALTY DISTRIBUTION SERVICES, INC.
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 4600 N HANLEY RD STE B
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City | SAINT LOUIS
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State | MO
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Zip | 63134-2715
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Country | US
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Telephone | 800-332-5455
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Fax | 877-304-9042
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Provider Business Mailing Address
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Address Line | 21162 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1238
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Country | US
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Telephone | 800-332-5455
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Fax | 877-304-9042
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | SUSAN PEPPERS
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Credential |
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Telephone | 513-858-4916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 2000168119
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License Number State | MO
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