MEDICARE: EXPRESS SCRIPTS SPECIALTY DISTRIBUTION SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	2000168119	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2632847	OTHER		OTHER ID NUMBER COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467534826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS SCRIPTS SPECIALTY DISTRIBUTION SERVICES, INC.

Provider Business Mailing Address
First Line	:	21162 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1238
Country	:	US
Telephone Number	:	800-332-5455
Fax Number	:	877-304-9042

Provider Business Practice Location Address
First Line	:	4600 N HANLEY RD STE B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-2715
Country	:	US
Telephone Number	:	800-332-5455
Fax Number	:	877-304-9042

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	SUSAN PEPPERS
Credential	:
Telephone Number	:	513-858-4916

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	05/10/2023

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