NPIViewer - Provider NPI 1275740474

NPI:	1275740474
Name:	ACCREDO HEALTH GROUP INC
Entity type:	Organization
Organization Name:	ACCREDO HEALTH GROUP INC
Other - Org Name:
Other - Org Type:
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:	314-684-6924
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:	1620 CENTURY CENTER PKWY
Practice Address - Street 2:	SUITE 109
Practice Address - City:	MEMPHIS
Practice Address - State:	TN
Practice Address - Zip Code:	38134-8849
Practice Address - Country:	US
Practice Address - Phone:	901-385-3600
Practice Address - Fax:	888-302-1028
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2007-05-17
Last Update Date:	2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:

State	License ID	Taxonomies
TN	3946	333600000X
		3336M0002X, 3336S0011X

Primary?	Code	Type	Classification	Specialization
Yes	333600000X	Suppliers	Pharmacy
No	3336M0002X	Suppliers	Pharmacy	Mail Order Pharmacy
No	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy

State	Identifier ID	ID Type	Issuer
MS	09753251	Medicaid
MS	09824589	Medicaid
TN	1455112	Medicaid
TN	4436920	Medicaid
SD	8533812	Medicaid
IA	0578625	Medicaid
WY	113194005	Medicaid
AR	158995407	Medicaid
	2095288	Other	PK
TN	4105365	Medicaid
MI	4436920	Medicaid
HI	508187	Medicaid
MO	603030503	Medicaid
MN	188488300	Medicaid
MD	4094506-00	Medicaid
WA	6027692	Medicaid
NM	99102048	Medicaid
DC	035891400	Medicaid
OK	100245100C	Medicaid
MT	1346208949	Medicaid
NJ	0103012	Medicaid
NY	02718770	Medicaid
PA	1007777870023	Medicaid
IN	200494710A	Medicaid
KY	54008214	Medicaid
ID	806981800	Medicaid
KY	100245100C	Medicaid
IN	200445	Medicaid
TN	4090811	Medicaid
WA	8095002	Medicaid
NJ	0102997	Medicaid
ME	160980000	Medicaid
ND	21460	Medicaid
OH	2487385	Medicaid
NH	30703864	Medicaid
AZ	927957	Medicaid
AK	PH536TN	Medicaid
WY	113194005	Medicaid
UT	=========001	Medicaid
ID	806981800	Medicaid