Provider Demographics
NPI:1285716647
Name:ESI MAIL PHARMACY SERVICE INC
Entity type:Organization
Organization Name:ESI MAIL PHARMACY SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASST. SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-858-4916
Mailing Address - Street 1:433 RIVER ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:433 RIVER ST
Practice Address - Street 2:SUITE 800
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2250
Practice Address - Country:US
Practice Address - Phone:800-888-8090
Practice Address - Fax:518-266-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0247083336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3340748OtherOTHER ID NUMBER-COMMERCIAL NUMBER