MEDICARE: EXPRESS SCRIPTS PHARMACY 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	333600000X	Pharmacy
2	3336M0002X	Mail Order Pharmacy	PH27304	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2143947	OTHER		PK

General Provider Information

NPI Number	:	1639266836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS SCRIPTS PHARMACY INC

Provider Business Mailing Address
First Line	:	13051 N TELECOM PKWY
Second Line	:	SUITE 150
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33637-0929
Country	:	US
Telephone Number	:	813-317-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	13051 N TELECOM PKWY STE 150
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33637-0929
Country	:	US
Telephone Number	:	813-317-2900
Fax Number	:

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

Provider Enumeration Date	:	10/07/2006
Last Update Date	:	12/05/2025

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