MEDICARE: ACCREDO HEALTH GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	3336H0001X	Home Infusion Therapy Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336S0011X	Specialty Pharmacy
5	333600000X	Pharmacy	22254	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2097264	OTHER	PK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073569034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCREDO HEALTH GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 954041
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-7568
Country	:	US
Telephone Number	:	901-381-7141
Fax Number	:	901-261-6924

Provider Business Practice Location Address
First Line	:	4343 W ROYAL LN
Second Line	:	STE 124
City	:	IRVING
State	:	TX
Zip	:	75063-2324
Country	:	US
Telephone Number	:	972-929-6800
Fax Number	:	972-929-6945

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	VIC PERINI
Credential	:
Telephone Number	:	314-684-6273

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	12/05/2025

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Directions to “ACCREDO HEALTH GROUP INC ” Practice Location

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