NPIViewer - Provider NPI 1306804547

NPI:	1306804547
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:	730 COOL SPRINGS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:	FRANKLIN
Practice Address - State:	TN
Practice Address - Zip Code:	37067-7290
Practice Address - Country:	US
Practice Address - Phone:	615-352-2500
Practice Address - Fax:	615-850-5100
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-05-03
Last Update Date:	2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:

State	License ID	Taxonomies
		332B00000X, 3336C0003X, 3336H0001X, 3336S0011X
TN	3972	333600000X

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	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy
No	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy

State	Identifier ID	ID Type	Issuer
KY	54008248	Medicaid
MD	409451400	Medicaid
ID	806978700	Medicaid
AK	PH535TN	Medicaid
IN	200482390A	Medicaid
TN	3697962	Medicaid
MI	4437225	Medicaid
TN	4437225	Medicaid
MN	1306804547	Medicaid
SC	7T3972	Medicaid
AZ	871419	Medicaid
IA	0578617	Medicaid
AL	100550027	Medicaid
PA	1007777870022	Medicaid
MT	1306804547	Medicaid
IN	200391	Medicaid
NM	23030887	Medicaid
CT	003123974	Medicaid
VA	010229065	Medicaid
OK	100245100D	Medicaid
AR	158998407	Medicaid
	2094102	Other	PK
OH	2487376	Medicaid
TX	580072	Medicaid
WA	6027528	Medicaid
MO	602876302	Medicaid
WA	6027528	Medicaid
IL	=========027	Medicaid
	P00370367	Medicare PIN
OK	100245100D	Medicaid