Provider Demographics
NPI:1689623555
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 - Prefix:
Authorized Official - First Name:VIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PERINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-684-6273
Mailing Address - Street 1:PO BOX 954041
Mailing Address - Street 2:
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 1:361 INVERNESS DR S
Practice Address - Street 2:STE F
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5860
Practice Address - Country:US
Practice Address - Phone:303-799-6550
Practice Address - Fax:303-799-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336H0001X, 3336S0011X
COPDO.0370000032333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1689623555Medicaid
NM03230562Medicaid
CO03003696Medicaid
NM98751867Medicaid
2002099OtherPK
NM98751867Medicaid