ACCREDO HEALTH GROUP INC

Provider Demographics

• NPI: 1417915653
• Name: ACCREDO HEALTH GROUP INC
• Entity Type: Organization
• Organization Name: ACCREDO HEALTH GROUP INC
• Other - Org Name: ACCREDO HEALTH GROUP INC
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: ASSISTANT SECRETARY
• Authorized Official - First Name: VIC
• Authorized Official - Last Name: PERINI
• Authorized Official - Phone: 314-684-6924
• Mailing Address - Street 1: PO BOX 954041
• Mailing Address - City: SAINT LOUIS
• Mailing Address - State: MO
• Mailing Address - Zip Code: 63195-0001
• Mailing Address - Country: US
• Mailing Address - Phone: 901-381-7141
• Mailing Address - Fax: 901-261-6924
• Practice Address - Street 1: 3000 ERICSSON DR
• Practice Address - Street 2: SUITE 100
• Practice Address - City: WARRENDALE
• Practice Address - State: PA
• Practice Address - Zip Code: 15086-6501
• Practice Address - Country: US
• Practice Address - Phone: 724-772-6000
• Practice Address - Fax: 724-742-2450
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-03
• Last Update Date: 2019-10-07

Provider Licenses

State	License ID	Taxonomies
		332B00000X, 3336C0003X, 3336C0004X, 3336H0001X, 3336S0011X
PA	PP415423L	333600000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	333600000X	Suppliers	Pharmacy
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy
No	3336C0004X	Suppliers	Pharmacy	Compounding Pharmacy
No	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy
No	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NJ	0014681	Medicaid
NY	02364978	Medicaid
OK	100245550B	Medicaid
TN	4582531	Medicaid
OR	500400005	Medicaid
SC	7P5423	Medicaid
ID	806196100	Medicaid
PA	PPA99169	Medicaid
NJ	0014699	Medicaid
CT	003097591	Medicaid
AR	134364741	Medicaid
ME	160980002	Medicaid
IN	200393	Medicaid
OH	2094317	Medicaid
TN	3974892	Medicaid
SC	DM1235	Medicaid
DC	018650500	Medicaid
PA	0397489	Medicaid
DE	1000016072	Medicaid
WY	113194002	Medicaid
AZ	334178	Medicaid
MT	5601857	Medicaid
PA	7397489	Medicaid
VA	8517690	Medicaid
AK	PH235PA	Medicaid
OK	100245550A	Medicaid
VT	1008681	Medicaid
MT	1417915653	Medicaid
VA	9117784	Medicaid
IN	200073250A	Medicaid
WA	6021851	Medicaid
NM	71979760	Medicaid
HI	508187	Medicaid
NM	62246	Medicaid
ID	000201600	Medicaid
CT	003140233	Medicaid
MD	223504800	Medicaid
MI	3974892	Medicaid
RI	OH24981	Medicaid
DE	0000847007	Medicaid
PA	1007777870026	Medicaid
OR	165745	Medicaid
	2083963	Other	PK
MD	321404400	Medicaid
CO	83480323	Medicaid
KY	9025743700	Medicaid
RI	OH24982	Medicaid
VA	9117784	Medicaid
MT	5601857	Medicaid
MI	3974892	Medicaid